Iatrogenic problems
There are a lot of iatrogenic problems in the hospital. Medications were considered to the most common causes of iatrogenic problems.
The incidence of iatrogenic disease is between 3.4% and 33.4% (sorry, I forgot the reference).
In our case,
67 year old man admitted to our hospital for a abdominal aortic aneurysm repair. Lorazepam, levothyroxine, carvediolol have been administered for a long time, as a treatment of anxiety, hypothyroidism, and heart failure respectively. The surgery succeeded as scheduled without problems, and extubated soon after operation. The drugs just mentioned above were stopped because he couldn't eat orally.
When it was the post operation day 1, the systemic involuntary movements happened after he got awake. His consciousness was alert and well-oriented. There were no cranial nerve dysfunction, weakness, sensory impairments. In the morning, his involuntary movements seems to be a balisms (too hyperactive as a myoclonus, but too simple as a chorea) , and intravenous diazepam administration could easily controlled his movements. The movements altered to be negative myoclonus in the afternoon.
The glucose, vitamine, electrolyte, ammmonium, thyroid functions were within normal range.
Head CT couldn't find any bleedings or mass lesion.
So, I concluded that the mechanism of this movements were resulted from the withdrawal of benzodiazepine or beta-blockers.
The drugs re-started as soon as possible, and these involuntary movements completely disappeared.
I thought it was avoidable iatrogenic case.
I should take care about my drug administration whether it is really needed to the patients.
