Prolonged lower limb dystonia and dysphonia following general anaesthesia in a patient on Hydroxyzine

A female patient in her early 40s presented with prolonged lower limb dystonia following general anaesthesia in multiple occasions. She once developed transient aphasia and prolonged dysphonia after total intravenous anaesthesia. She had uneventful anaesthetics before the prescription of hydroxyzine for her skin condition. All post anaesthetic dystonic events were reported while she was on hydroxyzine. Spasmodic laryngeal dystonia can result in dysphonia. The possible mechanisms of dystonia can be explained using a compartmental model of the striatum. An imbalance between cholinergic and dopaminergic systems in basal ganglia results in dystonic reactions. Changes in the endocannabinoid system could partly explain the effects on movement disorders after propofol administration. Antagonistic effect of hydroxyzine on dopamine 2 receptors in the striatum can result in predominant excitatory motor effects and movement disorders. Detailed history of the patient and analysis of findings with the clinical knowledge is important for the management of rare perioperative presentations of movement disorders.