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Chapter: Clinical Anesthesiology: Anesthetic Management: Anesthesia for Patients with Neurologic & Psychiatric Diseases

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Anesthesia for Neuroleptic Malignant Syndrome

Neuroleptic malignant syndrome is a rare complica-tion of antipsychotic therapy that may occur hours or weeks after drug administration.

NEUROLEPTIC MALIGNANT SYNDROME

Neuroleptic malignant syndrome is a rare complica-tion of antipsychotic therapy that may occur hours or weeks after drug administration. Meperidine and metoclopramide can also precipitate the disorder. The mechanism is related to dopamine blockade in the basal ganglia and hypothalamus and impairment of thermoregulation. In its most severe form, the pre-sentation is similar to that of malignant hyperther-mia. Muscle rigidity, hyperthermia, rhabdomyolysis, autonomic instability, and altered consciousness are seen. Creatine kinase levels are often high. The mortality rate approaches 20% to 30%, with deaths occurring primarily as a result of renal failure or arrhythmias. Treatment with dantrolene seems to be effective; bromocriptine, a dopamine agonist, may also be effective. Differential diagnoses include malignant hyperthermia and serotonin syndrome.

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