Severe Clonic Movement of Extremities suspected as Conversion Reaction after Continuous Epidural and General Anesthesia / 대한마취과학회지

ABSTRACT

Spontaneous shivering-like postanesthetic tremor occurs in about 40% of patients during recovery from all types anesthesia. Although most postoperative tremor is associated with intraoperative hypothermia, some is abnormal, centrally mediated thermoregulatory shivering. Conversion reactions are well known pathologic means to reduce uncontrolled anxiety and one of conversion symptom is clonic movement. 26-year old woman was brought to the operating room for surgery of ovarian cyst torsion. We had done combined continuous epidural and general anesthesia induced by pentothal sodium, succinylcholine, followed endotracheal intubation and maintained by inhalation of N2O-O2 (4 2) We experienced severe localized clonic movement of upper extremities of the patient during recovery from general anesthesia. Clonic movement was not easily controlled by valium and naloxon. Patient had past history of unstable emotion and experienced pain during early period of epidural anesthesia, but her vital signs including body temperature were stable. We could not find any physical causes. Result of psychological review disclosed patient's clonic movement conversion reaction. Frequency and degree of clonic movement was reduced by psychiatric manipulation and lorazepam after 3 hours of recovery from anesthesia. Several episodes of clonic movement had developed at ward but she could discharged without any other complications.