From the Guidelines
The Pagnini-McClure maneuver is not mentioned in the provided evidence, and therefore, its description and application cannot be determined based on the given studies. The provided evidence discusses the management of supraventricular tachycardia (SVT), including recommendations for vagal maneuvers, adenosine administration, and synchronized cardioversion 1.
Key Points
- Vagal maneuvers, including Valsalva and carotid sinus massage, are recommended for acute treatment in patients with regular SVT 1.
- Adenosine is recommended for acute treatment in patients with regular SVT, with success rates ranging from 78% to 96% 1.
- Synchronized cardioversion is recommended for acute treatment in patients with hemodynamically unstable SVT when vagal maneuvers or adenosine are ineffective or not feasible 1. Since the Pagnini-McClure maneuver is not mentioned in the provided evidence, its effectiveness and safety cannot be evaluated based on the given studies.
Considerations
- The evidence provided focuses on the management of SVT, and does not address the diagnosis or treatment of benign paroxysmal positional vertigo (BPPV) or other conditions that may be related to the Pagnini-McClure maneuver.
- In clinical practice, it is essential to rely on evidence-based recommendations and guidelines when managing patients with specific conditions, such as SVT or BPPV. Given the lack of information on the Pagnini-McClure maneuver in the provided evidence, it is not possible to make a recommendation on its use or application.
From the Research
Definition and Purpose of the Pagnini-McClure Maneuver
- The Pagnini-McClure maneuver is a diagnostic technique used to identify benign paroxysmal positional vertigo (BPPV), specifically lateral canalolithiasis 2, 3, 4, 5.
- This maneuver involves a head roll in the yaw plane in a supine position, which can induce paroxysmal horizontal bidirectional positioning nystagmus in patients with lateral canal BPPV 5.
- The purpose of the Pagnini-McClure maneuver is to diagnose and lateralize the affected ear in patients with lateral canal BPPV, by eliciting nystagmus and determining its direction and intensity 2, 5.
Characteristics of the Pagnini-McClure Maneuver
- The maneuver can induce paroxysmal horizontal unidirectional positioning nystagmus in some cases, which is characterized as "direction-fixed paroxysmal nystagmus lateral canal BPPV" 5.
- In geotropic forms of lateral canalolithiasis, the fast phase of the nystagmus is directed towards the lowermost ear, while in apogeotropic forms, the fast phase is directed towards the uppermost ear 2, 5.
- The intensity of the nystagmus can vary between the affected and healthy sides, with the nystagmus being more intense on the affected side in geotropic forms and more intense on the healthy side in apogeotropic forms 2.
Clinical Applications of the Pagnini-McClure Maneuver
- The Pagnini-McClure maneuver is a useful diagnostic tool for identifying lateral canal BPPV and determining the affected ear 2, 3, 4, 5.
- The maneuver can be used in conjunction with other diagnostic tests, such as the Dix-Hallpike test, to confirm the diagnosis of BPPV 3, 6.
- The results of the Pagnini-McClure maneuver can inform treatment decisions, such as the use of canalith repositioning maneuvers or vestibular rehabilitation exercises 6.