Sodium Nitroprusside and Epidural Blockade in the Treatment of Ergotism

Andersen, P. K.; Christensen, K N; Hole, P; Juhl, B.; Rosendal, T; Stokke, D. B.

doi:10.1056/nejm197706022962208

Cited by 33 publications

(3 citation statements)

References 8 publications

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“…Sympathetic block produced by epidural anesthesia inhibits the sympathetic nervous system but does not reverse the vasoconstriction produced by a drug that acts directly on the vascular smooth muscle. 37 The use of hyperbaric oxygen alone has also been reported to be a successful treatment for vascular insufficiency from ergotism. 37 The use of mechanical intra-arterial balloon dilatation as used in one of our patients has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…37 The use of hyperbaric oxygen alone has also been reported to be a successful treatment for vascular insufficiency from ergotism. 37 The use of mechanical intra-arterial balloon dilatation as used in one of our patients has been reported. 31 The mechanism of relief of the arterial spasm with intralumhaal balloon angioplasty is thought to bc from damage to the smooth muscle of the media, which renders the artery noncontractilc in response to the vasoconstrictivc stimuli of Cafergot.…”

Section: Discussionmentioning

confidence: 99%

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Recognition and treatment of arterial insufficiency from Cafergot

Wells

Steed

Zajko

et al. 1986

Journal of Vascular Surgery

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Cafergot is a combination of ergotamine tartrate and caffeine and may cause symptoms of peripheral vascular insufficiency. Iatrogenic ergotism should be suspected in any patient exhibiting ischemic symptoms while receiving this medication. Progression to fulminant necrosis and gangrene can occur. Two cases are presented and the management reviewed. This effect of ergotamine tartrate and caffeine may be an idiosyncratic hypersensitivity reaction with therapeutic doses or may result from excessive medication. Iatrogenic ergotism occurs most often in women in their mid-thirties with migraine syndrome. By alpha-adrenergic agonism, as well as by possible interactions with prostaglandins, calcium, and serotonin, ergotamine causes vasoconstriction of both arteries and veins. The angiographic pattern of spasm, collateral formation, and intravascular thrombi is typical. Treatment of ergotism depends on the severity of the symptoms and the possibility of gangrene. Discontinuation of ergotamine, cigarette smoking, and caffeine may be all that is necessary in most patients. Nitroprusside is the drug of choice in the treatment of acute vascular insufficiency from ergotism, but in a less urgent situation, prazosin has also been effective. Intra-arterial balloon dilatation has also been helpful. Other forms of therapy have been supportive and the results inconsistent. Cafergot should be used with extreme caution in patients with renal or hepatic failure, peripheral vascular disease, or pregnancy. Relative contraindications include hypertension, ischemic heart disease, and Raynaud's phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recognition and treatment of arterial insufficiency from Cafergot

Wells

Steed

Zajko

et al. 1986

Journal of Vascular Surgery

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“…The following treatments have been recommended : withdrawal of ergotamine ( JACOBSEN 1967, LUND-ANDERSEN 1970, anticoagulation (HENRY et al 1975), lumbar sympathetic block or epidural analgesia (SEMB et al 1975), rheomacrodex (HENRY et al 1975, reserpine (GREENE et al 1977), phenoxybenzamine ( H E S S O V~~ al. 1972, WALLIN & KJ~RGARD 1977, sodium nitroprusside (ANDERSEN et al 1977), and hyperbaric oxygenation (ELOFF et al 1963, MOGENSEN & JACOBSEN 1974. Most reports deal with a single case or only a few cases.…”

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confidence: 99%

Ergotism Treated with Hyperbaric Oxygen and Continuous Epidural Analgesia

Merrick

Gufler

Jacobsen

1978

Acta Anaesthesiol Scand

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Eight patients suffering from severe ergotamine-induced peripheral ischaemia were transferred to our institution for hyperbaric oxygen treatment after unsuccessful therapy in the primary hospital. The patients were exposed to 3 ATBS oxygen for 1 hour 2-3 times daily and they were given an epidural block for the purpose of analgesia where there was severe pain. The circulation and vitality of tissue were restored in all patients. One had tarsal amputations performed half a year later. Hyperbaric oxygen in combination with epidural analgesia is recommended in severe cases of ergotism.

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Prazosin Treatment of Ergotamine-Induced Peripheral Ischemia

Cobaugh¹

1980

JAMA

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Sodium Nitroprusside and Epidural Blockade in the Treatment of Ergotism

Cited by 33 publications

References 8 publications

Recognition and treatment of arterial insufficiency from Cafergot

Recognition and treatment of arterial insufficiency from Cafergot

Ergotism Treated with Hyperbaric Oxygen and Continuous Epidural Analgesia

Prazosin Treatment of Ergotamine-Induced Peripheral Ischemia

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