Phenothiazine induced lingual trauma

Abstract

A 34‐year‐old woman presented with an unusual and unfortunate combination of complications to a phenothiazine drug. Rhythmic protrusion of her tongue was not a problem until it became trapped outside of her oral cavity by spasm of the muscles of mastication. Massive edema with questionable viability of her tongue ensued. She presented as an airway as well as therapeutic management problem.

Sedation With Promethazine Profoundly Affects Spontaneous Airway Protection in Sleeping Neonatal Piglets

“…30 Furthermore, the reflex augmentation of intercostal muscle activity during obstructed breathing is lost, 31 pulmonary O2 stores are reduced (hypoxaemia develops rapidly 32 ) and the reflex defence to hypoxaemia (ventilatory and arousal responses) is depressed. 36 Spontaneous GOR to the pharynx may also have contributed to the increase in both central and obstructive apnoea via stimulation of the LCR. The results in the present study are consistent with those of an infant study where promethazine was linked to an increase in both central and obstructive sleep apnoea, when measured on the third day of promethazine administration.…”

“…7 The increase in obstructive sleep apnoea observed in the piglets may have resulted from the side effects of promethazine, including hypotonia of the upper airway muscles, 34 laryngospasm 35 or airway obstruction through spasm of the tongue. 36 Spontaneous GOR to the pharynx may also have contributed to the increase in both central and obstructive apnoea via stimulation of the LCR. 12 The attenuation of these normal protective mechanisms may result in a neonate becoming vulnerable to an ALTE, following pharyngeal fluid stimulation (arising from GOR, nasopharyngeal secretions or upper respiratory tract infections).…”