Neurosurgery notes/Procedures/Cranial procedures/Functional cranial procedures/Spasm/ITB Overdose

ITB Overdose

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Spasm

Due to

  • Errors in programming
  • Error in pump refilling
    • Pocket fill
      • When refilling the pump, it is vital to ensure that the needle is inserted into the pump itself
      • Do not let the baclofen be filled accidentally into the pump pocket (a pocket- fill)
      • A life threatening situation that requires immediate aspiration of drug from the pocket
      • May require supportive ventilation on intensive care unit (ICU) for the patient until the baclofen wears off.

Clinical features

  • Can mimic symptoms associated with sepsis, intracranial hemorrhage, hypoglycemia, Cushing’s triad, electrolyte imbalance, and seizure disorder.
  • Initial
    • Nausea and vomiting
    • Dizziness
    • Respiratory depression
    • Hypothermia
    • Rostral progression of hypotonia
    • Somnolence
  • Severe
    • Seizures
    • Coma requiring ventilatory support
 
  • EEG
    • An increase of slow wave activity and periodic shape waves associated with epileptiform discharges

Treatment

  • Initial management: Supportive
    • Maintenance of airway, respiration, and circulation
    • Intubation and ventilatory support may be necessary.
    • Some individuals may be at risk for seizure development and preventative measures should be considered.
    • Most patients recover completely from baclofen overdose with supportive care, fluids, and ventilatory support.
  • Subsequent management
    • Reduction or temporary interruption of ITB delivery by pump reprogramming.
  • Optional measures for ITB overdose
    • CSF drainage via CAP aspiration
    • Sequential lumbar punctures or lumbar drains.
    • While physostigmine has been reported to reduce central side effects such as somnolence and respiratory depression
      • The panel strongly advised against the use of this medication in the majority of ITB overdose cases
      • Physostigmine may produce adverse effects such as bradycardia, seizures, and increased respiratory secretions, which can increase the risk and harm to the somnolent or comatose patient requiring supportive care.
  • Patients who are treated for baclofen overdose must be watched closely for rebound withdrawal once the pump is stopped and the drug load is decreased.