The incidence of postoperative nausea and vomiting (PONV) after oral and maxillofacial surgery is high, and the prevention of PONV is important for patient comfort after surgery. Droperidol and metoclopramide hydrochloride, two dopamine receptor antagonists, are widely used for the prevention and treatment of PONV. However, one of the adverse effects of these drugs is extrapyramidal symptoms (EPS). We report a case of EPS after the administration of droperidol and metoclopramide hydrochloride following orthognathic surgery.
A 19-year-old woman underwent orthognathic surgery under general anesthesia. Dexamethasone sodium phosphate (6.6 mg) was administered prior to the start of surgery, and droperidol (1.25 mg) was administered at the end of surgery for the prevention of PONV. After the completion of the surgery, an intravenous patient-controlled analgesia (IV-PCA) device was used for postoperative analgesia (contents : fentanyl citrate, 20 ml [1 mg] and droperidol, 2 ml [5 mg] diluted with saline [28 ml]). Immediately after returning to the ward, metoclopramide hydrochloride (10 mg) was administered because the patient developed nausea. Fourteen hours and 30 minutes after the end of surgery, the patient noticed sursumvergence and torticollis. Since the patient’s consciousness was clear and her vital signs were stable, the use of droperidol in combination with metoclopramide hydrochloride was suspected of having caused the EPS. Thus, IV-PCA was discontinued, and her symptoms resolved after 2 hours.
In the present case, the EPS were likely attributable to the inclusion of droperidol in the IV-PCA. Therefore, we believe that EPS should be prevented by reducing the dose of droperidol or administering serotonin receptor antagonists (ondansetron and granisetron) as alternatives.
