Muscle movement

Propanidid. Propanidid [1421-14-3] (Epontol), C gH2yNO, (7) a derivative of the propyl ester of homo vanillic acid, has been in clinical use in Europe for a number of years. Its main advantage is rapid onset of action and a fast recovery which, like etomidate, is because of rapid metaboHsm by esterases rather than redistribution (108). Excretion is rapid 75 to 90% of the dmg is eliminated as metaboUtes within two hours. Propanidid side effects include hypotension, tachycardia, and hyperventilation followed by apnea, as well as excitatory side effects such as tremor and involuntary muscle movement (109). 

Among the most significant adverse reactions associated with the antipsychotic dm are the extrapyramidal effects. The term extrapyramidal effects refers to a group of adverse reactions occurring on the extrapyramidal portion of the nervous system as a result of antipsychotic drains. This part of the nervous system affects body posture and promotes smooth and uninterrupted movement of various muscle groups. Antipsychotics disturb the function of the extrapyramidal portion of the nervous system, causing abnormal muscle movement. Extrapyramidal effects include Parkinson-like symptoms (see Chap. 29), akathisia, and dystonia (see Display 32-1). 

Absence Sudden and brief (i.e., several seconds in duration) losses of consciousness without muscle movements. These seizures are often described as daydreaming or blanking out episodes. A common term for these seizures is petit mal. ... 

Atonic The patient loses consciousness and muscle tone. No muscle movements are typically noted, and the patient... 

Simple The patient will have a sensation or uncontrolled muscle movement of a portion of their body without an alteration in consciousness. The type of sensation or movement is dependent on the location of seizure in the brain. 

The extrapyramidal motor system controls muscle movement through a system of pathways and nerve tracts that connect the cerebral cortex, basal ganglia, thalamus, cerebellum, reticular formation, and spinal neurons. Patients with PD lose dopamine neurons in the substantia nigra, which is located in the midbrain within the brain stem. The substantia... 

Motor tics Sudden, involuntary muscle movements (e.g., spasms). 

Nocturnal polysomnography Visual and electrophysiologic assessment of human sleep minimally composed of electroencephalogram, electrooculogram, and electromyogram that allows determination of sleep stage, breathing events, and muscle movements. 

Figure 3. Time structure and patterns in the eye-brow-flash. The figure shows two different patterns in a eye-brow-flash. The prototypical pattern in (a) was described by Eibl-Eibesfeldt (1972). This pattern starts with a frown which disappears. The brows are lifted quickly and a smile is added. The brow raise disappears, while the smile can stay on the face. The second pattern (b) is completely different It also starts with a frown, which does not disappear whilst the brow raise appears on the face. The brow raise onset duration is three times as long as in the first pattern and the pattemsduration is much longer than in (a) (Grammer et al 1989). In addition to the difference in combinations of muscle movements there is also a difference in the time structure which changes the quality of the expression.

Amyotrophic lateral sclerosis (ALS) is a disease of the neurons that control muscle movement (motor neurons). Degeneration of neurons causes muscle atrophy eventually impairing the movement of people afflicted with the disease. 

It is time to build a little more on the structure that we have established. To provide a concrete example, we shall consider one aspect of the peripheral nervous system, PNS. As discussed above, the efferent PNS carries information from the CNS to the muscles movement results. 

Etomidate may cause pain on injection and may produce myoclonic muscle movements in approximately 40% of patients during its use as an induction anesthetic. In addition, etomidate can suppress the adrenocortical response to stress, an effect that may last up to 10 hours. 

The most notable differences from thiopentone consist of a high incidence of spontaneous muscle movements, tremor and hypertonus (20% compared with 4% for thiopentone). The incidence is directly related to the dose and rate of administration and is increased by drugs, such as hyoscine and droperidol, and decreased by opioid premedication. Respiratory complications. 

Etomidate Rapid onset and moderately fast recovery Provides cardiovascular stability causes decreased steroidogenesis and involuntary muscle movements... 

Etomidate is a carboxylated imidazole that can be used for induction of anesthesia in patients with limited cardiovascular reserve. Its major advantage over other intravenous anesthetics is that it causes minimal cardiovascular and respiratory depression. Etomidate produces a rapid loss of consciousness, with minimal hypotension even in elderly patients with poor cardiovascular reserve. The heart rate is usually unchanged, and the incidence of apnea is low. The drug has no analgesic effects, and coadministration of opioid analgesics is required to decrease cardiac responses during tracheal intubation and to lessen spontaneous muscle movements. Following an induction dose, initial recovery from etomidate is less rapid (< 10 minutes) compared with recovery from propofol. 

Etomidate causes a high incidence of pain on injection, myoclonic activity, and postoperative nausea and vomiting. The involuntary muscle movements are not associated with electroencephalographic epileptiform activity. Etomidate may also cause adrenocortical suppression via inhibitory effects on steroidogenesis, with decreased plasma levels of cortisol after a single dose. Prolonged infusion of etomidate in critically ill patients may result in hypotension, electrolyte imbalance, and oliguria because of its adrenal suppressive effects. 

It is believed that LSD works by stimulating the effects of serotonin in the brain. This would help explain why all of the senses are usually enhanced or distorted (synesthesia) in people taking LSD and why the drug has a profound effect on mood, thinking, and some basic bodily functions such as temperature control and muscle movement. 

Methaqualone affects muscle movement and proper functioning of nerve sensation. Users experience paresthesia, which is a numb tingling, or pins and needles sensation, most commonly in the fingers and face. Individuals who take heavy doses of methaqualone also have a heightened pain threshold. The coordination of brain and body becomes disconnected, and nerve signals are slowed or stopped on their way to the brain s command center. While under the influence of methaqualone, users may hurt themselves without realizing it. 

This list ranks the neuroleptics in increasing order of causing sedation and in decreasing order of causing abnormal involuntary muscle movements and potency. All are equally effective in treating the symptoms of schizophrenia. 

Significant periods of movement are also evident during REM sleep periods, when REM sleep behavior disorder is present (117,138). These include vocalizations, increased muscle tone, and complex muscle movements. During NREM sleep, increased incidence of periodic limb movements is also evident in up to one third of Parkinson s patients (139). Muscle activity is often present in limbs that also express tremor during waking periods. 

Effects on respiration are similar to those of thiopental at usual anesthetic doses. However, propofol causes a marked decrease in systemic blood pressure during induction of anesthesia, primarily through decreased peripheral resistance. In addition, propofol has greater negative inotropic effects on the heart than etomidate and thiopental. Apnea and pain at the site of injection are common adverse effects of bolus administration. Muscle movements, hypotonus, and (rarely) tremors have also been reported following its use. Clinical infections due to bacterial contamination of the propofol emulsion have led to the addition of antimicrobial adjuvants (eg, ethylenediaminetetraacetic acid and metabisulfite). 

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