Metoclopramide and extrapyramidal symptoms: a case report

Metoclopramide is a useful medication in the anesthesia provider's armamentarium. Its primary indication in the preoperative phase is to reduce gastric contents and increase lower esophageal sphincter tone for pharmacologic pulmonary aspiration prophylaxis. Metoclopramide can precipitate extrapyramidal symptoms (EPS)/drug-induced movement disorders (DIMD). Tardive dyskinesia and Parkinsonism is generally seen after long-term use, whereas dystonia and akathisia can occur after a single dose of metoclopramide. Recognition of dystonia and/or akathisia by the perianesthesia nurse after the administration of metoclopramide is important for prompt treatment of this distressing condition. It is imperative that the perianesthesia nurse is knowledgeable in metoclopramide's basic pharmacology, uses as an anesthetic adjunct, guidelines for administration, and EPS/DIMD associated reactions, as well as measures that may reduce the incidence and/or facilitate treatment of this medication-induced condition. This case report presents a male patient in his 40s experiencing akathisia after a single 10-mg dose of metoclopramide.