Prolonged Lower Limb Dystonia and Dysphonia Following General Anesthesia in a Patient on Hydroxyzine

TL;DR

A patient on hydroxyzine developed prolonged dystonia and dysphonia after general anesthesia, possibly linked to propofol and hydroxyzine use.

Contribution

This case reports a rare correlation between hydroxyzine, propofol, and prolonged dystonia/dysphonia following anesthesia.

Findings

Prolonged lower limb dystonia and dysphonia occurred after general anesthesia in a patient on hydroxyzine.

Dystonic events were associated with propofol and concurrent hydroxyzine use, not seen in prior anesthetics.

Transient aphasia and spasmodic laryngeal dystonia were observed, not previously reported in such cases.

Abstract

We present a case of prolonged lower limb movement disorder following general anesthesia in a female patient in her early forties. She presented with vigorous, regular synchronous, rhythmic, and jerky movements during the immediate postoperative period lasting around forty minutes. Her past anesthetic history suggests varying degrees of postoperative movement disorders. Our patient was on long-term hydroxyzine for her skin condition. She had uneventful anesthetics before the prescription of hydroxyzine for her skin condition. All post-anesthetic dystonic events were reported while she was on hydroxyzine. Dystonic reactions during the perioperative period are rare and mostly occur during induction and emergence, which usually be transient. Our patient had prolonged lower limb dystonia resulting in severe muscular pain and lethargy for a few days. Further, she once developed transient aphasia and prolonged dysphonia following total intravenous anesthesia. This clinical finding could be a part of spasmodic laryngeal dystonia, which has not been reported previously. We correlate this rare postoperative dystonic reaction with propofol and possibly with the concurrent use of hydroxyzine.

As differential diagnosis can widely vary, the correlation of clinical findings with movement disorders is important for the diagnosis. Alterations of anesthetic techniques avoiding propofol and holding hydroxyzine are advisable in such rare clinical situations. Early diagnosis of perioperative movement disorders will prompt specific treatments, such as anticholinergic medications, for dystonia.

Figures