[Therapy of postoperative nausea and vomiting in ENT--tardive dyskinesia as an adverse effect of metoclopramid--a case report].
BACKGROUND
Postoperative nausea and vomiting (PONV) are among the most common complications in operative medicine. Especially patients undergoing middle ear surgery or stapedectomy are frequently suffering from PONV. On the other hand vertigo might be a symptom of an operative complication. For symptomatic therapy a various number of different drugs is available.


METHODS
We describe the clinical course of a 25-years-old female patient, who presented with massive orofacial tardive dsykinesia after therapy with metoclopramide (MCP). She had stapedectomy in general anaesthesia and suffered from PONV. The dyskinesia was treated successfully with Biperiden 5 mg i. v.


CONCLUSIONS
Tardive dyskinesia is a potential and in rare cases irreversible complication of MCP-therapy. The efficiacy of MCP is in controversy. Studies with 5-HT3-antagonists like Ondansetron or neuroleptics like Droperidol show good results in PONV especially after middle ear surgery.


CONCLUSIONS
Tardive dyskinesia is a rare but possible drug-related adverse effect of MCP. After review of the literature we can not recommend MCP as an antiemetic drug in PONV.
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde des Universitätsklinikums Hamburg-Eppendorf. stesche@t-online.de
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Tesche
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Henckell
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Metternich
D000328:Adult; D000932:Antiemetics / Q000009:adverse effects* / Q000627:therapeutic use; D001712:Biperiden / Q000627:therapeutic use; D004409:Dyskinesia, Drug-Induced / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005158:Facial Paralysis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects* / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D013201:Stapes Surgery
D000932:Antiemetics; D018727:Muscarinic Antagonists; D001712:Biperiden; D008787:Metoclopramide