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The adverse effects of phentermine and fenfluramine

Medical history was positive for a distant episode of hepatitis A and cessation of smoking 20 yr previously. Preoperative laboratory studies were unremarkable. Personal and family history were negative for anesthesia-related complications. He denied use of alcohol or illicit drugs.

Synergistic interactions between fenfluramine and phentermine.

All medications were prescribed by the patient's primary care physician. The patient refused to have a spinal anesthetic but agreed to an ankle block with sedation. Additionally, fentanyl was administered to a total titrated dose of 150 micro gram over approximately 20 min while a right ankle block was administered. After surgical prep, the case proceeded without incident until nearly completed.

At the time of the hypotension and bradycardia, the patient appeared calm and was responsive to verbal stimuli. He denied surgical discomfort, chest pain, shortness of breath, nervousness, or nausea.

  1. After the FDA put fen a call to medical professionals to report any such findings, 66 more cases were reported to the buy Medwatch program.
  2. Possible dangers of anaesthesia in patients receiving fenfluramine.
  3. Additionally, fentanyl was administered to a total titrated dose of 150 micro gram over approximately 20 min while a right ankle block was administered. An investigation fen the Mayo Clinic and Mayo Foundation found 24 cases of heart valve problems in patients taking fen-phen.
  4. The lawsuits were filed against the manufacturers, distributors and retailers, as well as against the pharmacists and can who prescribed and supplied the pills. Even though a substantial period of time had elapsed since the administration of the local anesthetic or sedation-analgesia, the patient remained comfortable, adequately sedated, and denied surgical pain.
  5. How to Lose Weight When Depressed. Additionally, one cannot rule out catecholamine depletion as a result of decreased reserves of norepinephrine from chronic drug therapy.

No change in ST segments, mental status, nor onset of diaphoresis was noted. Surgery was completed without further incident. He was receiving an FIO2of 0. He was placed in the supine position and noted to be diaphoretic. Glycopyrrolate was titrated to effect over the next 15—20 min.

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A dose of 0. After being symptom-free for about 40 min, diaphoresis was again noted when the patient resumed the mid-fowler's position but without change in vital signs.

A tilt-test was performed, and the results were negative. In addition, he denied malaise or nausea. After diaphoresis resolved, the remainder of recovery was uneventful. Cardiology service evaluated the patient but found no cardiac-related reason not to proceed with same-day discharge.

The patient returned 18 h later for postoperative evaluation and to have a troponin I level drawn. He denied recurrence of any postoperative symptomatology. Discussion Although multiple etiologies of perioperative hypotension exist, many potential causes may be ruled out as a result of our patient's lack of medical history, lack of physical findings, and normal preoperative laboratory values.

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We considered the possibility of a vasovagal-type reaction, although our patient manifested no signs of psychological distress and denied any emotional or physical discomfort. Even though a substantial period of time had elapsed since the administration of the local anesthetic or sedation-analgesia, the patient remained comfortable, adequately sedated, and denied surgical pain.

Considering this, we could find no satisfactory mechanism of vasovagal-mediated hypotension or bradycardia. The patient's troponin-I level was negative.

The adverse effects of phentermine and fenfluramine

This delay may point to the degree to which catecholamine reserves were decreased in relation to the amount of depression induced by the sedation-analgesia or local anesthetic.

Catecholamine reserves could have been consumed more rapidly had a more potent anesthetic been used. Autonomic dysfunction as a result of catecholamine depletion has been documented with general anesthesia. Indirect-acting sympathomimetics completely depend on sufficient neuronal stores of norepinephrine. Rapid intraoperative treatment may have averted the occurrence of associated manifestations diaphoresis, malaise, and so on. In contrast, delayed postoperative management of borderline hypotension and bradycardia may have allowed the occurrence of the symptoms that developed in the PACU.

Considering the dose of glycopyrrolate necessary to resolve the postoperative bradycardia and the length of time required before symptoms abated, the presence of autonomic dysfunction cannot be excluded.

Additionally, one cannot rule out catecholamine depletion as a result of decreased reserves of norepinephrine from chronic drug therapy. The authors thank Philip Greilich, M.

  • Results of animal studies following a case of human cardiac arrest;
  • Indirect-acting sympathomimetics completely depend on sufficient neuronal stores of norepinephrine;
  • Considering this, we could find no satisfactory mechanism of vasovagal-mediated hypotension or bradycardia;
  • Considering this, we could find no satisfactory mechanism of vasovagal-mediated hypotension or bradycardia.

Long-term weight control study: Clin Pharmacol Ther 1992; 51: American Hospital Formulary Service 97: Bennett J, Eltringham R: Possible dangers of anaesthesia in patients receiving fenfluramine: Results of animal studies following a case of human cardiac arrest. N Engl J Med 1997; 337 9: Syncope and hypotension, Heart Disease.

  • Diet Pills That Doctors Recommend;
  • In contrast, delayed postoperative management of borderline hypotension and bradycardia may have allowed the occurrence of the symptoms that developed in the PACU;
  • He denied recurrence of any postoperative symptomatology;
  • How to Lose Weight When Depressed;
  • Additionally, fentanyl was administered to a total titrated dose of 150 micro gram over approximately 20 min while a right ankle block was administered;
  • All medications were prescribed by the patient's primary care physician.

Edited by Braunwald E. Philadelphia, WB Saunders, 1997, pp 863-76. Diagnosis of perioperative myocardial infarction with measurement of cardiac troponin-I. N Engl J Med 1994; 330: The effects of alpha-methyldopa, reserpine, guanethidine, and iproniazid on minimum alveolar anesthetic requirement MAC.

Autonomic nervous system physiology and pharmacology, Clinical Anesthesia. Philadelphia, Lippincott-Raven, 1996, pp 319-84.