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Abstract
In Reply.— Dr Pettus raises interesting issues in his letter. Sympathetic hyperactivity occurs in NMS and manifestations include high blood pressure and tachycardia. The consequent increase in cardiac work in an older patient causes concern about the risk of myocardial infarction and this concern led us to use propranolol for symptomatic management. In a younger person in otherwise good health, we might have not chosen to use propranolol. There is no reason to believe propranolol by itself would have controlled the severe muscle rigidity, and it cannot be the primary medication in controlling NMS. It can, however, be a useful adjunct. The patient was given 10 mg of diazepam intramuscularly, with insignificant results the day before treatment with pancuronium began. Diazepam may be useful in reducing muscle rigidity in mild cases of NMS, but did not control the severe rigidity in our patient. Muscle paralysis through the use of pancuronium
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