全麻后血管性水肿

Mathilda Panggabean, Yutu Solihat
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引用次数: 0

摘要

背景:全身麻醉包括在相当短的时间内给病人使用多种药物。由于所给药物的反应,可能会发生许多负面后果,其中一个例子是过敏反应,如果不及时识别和处理,可能导致死亡。病例说明:一名67岁男性患者,身高152公分65公斤,患有多发性胆囊炎和阻塞性黄疸,计划行腹腔镜胆囊切除术。患者无药物及食物过敏记录。家族无过敏反应或血管性水肿记录。初诊时血压190/90 mmHg,血红蛋白10.4 g/dL,其余参数均在正常范围内。我们在手术中给予异丙酚和罗库溴铵来诱导放松和方便插管。注射罗库溴铵后约90分钟,患者出现面部/区域、舌头和口腔底血管性水肿。病人还抱怨不能说话。不久之后,我们给病人10毫克地塞米松和100毫克氢化可的松。在氢化可的松给药后60分钟内,患者表现出临床改善,以肿胀开始减少为标志,患者又能说话了。然后对患者进行血管性水肿的相关知识教育及警示。结论:过敏反应是一种对特定过敏原发生的超敏反应,大多是自限性的,但11%的超敏反应需要气道干预。大多数麻醉药物如硫喷妥钠、异丙酚、肌肉松弛剂和依托咪酯在麻醉诱导时可引起过敏反应。停用基础药物和气道控制可预防死亡率和发病率。
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Post-General Anesthesia Angioedema After General Anesthesia
Background: General anesthesia includes the administration of avariety medicines to patient/in/ fairly short/period. Numerous negative consequences can occur because of reaction from the drugs given, one example is anaphylaxis that may lead to death if not been recognized and handled quickly & promptly.Case Illustration: A sixty-seven years old male patient 152 cm 65 kg with multiple cholecystitis and obstructive jaundice, who was scheduled to undergo laparoscopic cholecystectomy. Patient had no records of allergy to medication and food. Family has no records to hypersensitive reactions or angioedema. At initial evaluation, blood pressure was 190/90 mmHg and hemoglobin 10,4 g/dL while the rest parameter was within normal limits. We given propofol and rocuronium to induce relaxation and facilitate intubation in surgery. Approximately 90 minutes after rocuronium injection, patient evolved angioedema across the face/area, tongue, and floor of the mouth. Patient also complained of not being able to talk. Soon after that, we give 10 mg of dexamethasone and 100 mg hydrocortisone to the patient. Within 60 minutes after hydrocortisone administration the patient shows/clinical improvement that marked by swelling began to decrease and the patient was able to speak again. Then we educate patient about angioedema and its alert.Conclusion: Anaphylaxis is a type of hypersensitivity response that take place to a particular allergen and mostly self-limited, but 11% of hypersensitive reaction require airway intervention. Most of anesthetic medication such as thiopental sodium, propofol, muscle relaxants, and etomidate may induce anaphylactic reaction during anesthesia induction. Discontinuation of underlying agent and airway control may prevent mortality and morbidity.
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