室间隔内注射利多卡因和肾上腺素溶液增强罗库肌松作用1例

IF 0.1 Q4 ANESTHESIOLOGY Acta anaesthesiologica Belgica Pub Date : 2020-03-01 DOI:10.56126/71.1.07
A.C. Bekono Zoa, C. Franssen, J. Brichant, C. Czarnetzki
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引用次数: 0

摘要

各种药物和生理障碍影响神经肌肉阻滞剂的作用。如果麻醉师忽略了一些,例如没有监测神经肌肉功能,则患者可能面临与术后残余curarization相关的潜在严重后果的风险。病例介绍:一位67岁的女性患者在全身麻醉下接受了鼻中隔成形术,并进行了基本的监测(三导通心电图、无创血压、二氧化碳和SpO2的潮末分压)和使用拇内收肌加速肌图监测神经肌肉功能。用异丙酚和舒芬太尼诱导全身麻醉。神经肌肉监测校准后,给予单剂量罗库溴铵。此后气管插管,七氟醚维持麻醉。罗库溴铵给药102分钟后,在切口前立即在鼻中隔粘膜下注射含有5µg/mL肾上腺素的1%利多卡因溶液。注射后2分钟,四列比值明显降低。大约13分钟后恢复到粘膜下注射前的记录值。结论:肾上腺素增加了罗库溴铵所达到的肌肉松弛程度,即使在神经肌肉功能恢复时也是如此。考虑到许多药物和因素干扰神经肌肉阻滞剂的作用,监测是排除术后残余curarization风险的唯一手段。
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Enhancement of muscle relaxant effect of rocuronium by intraseptal injection of a solution containing lidocaïne and epinephrine : a case report
Introduction : Various drugs and physiologic disturbances affect the action of neuromuscular blocking agents. If some are ignored by the anesthesiologist, e.g. in the absence of monitoring of neuromuscular function, the patient may be at risk of potentially severe consequences related to postoperative residual curarization. Case presentation : A 67-year-old female patient underwent septoplasty under general anesthesia with basic monitoring (three-lead electrocardiogram, non-invasive blood pressure, end-tidal partial pressure of carbon dioxide and SpO2) and a monitoring of neuromuscular function using acceleromyography of the adductor pollicis. General anesthesia was induced with propofol and sufentanil. After neuromuscular monitoring calibration, a single dose of rocuronium was given. Thereafter the trachea was intubated and anesthesia was maintained with sevoflurane. One hundred and two minutes after the administration of rocuronium, a 1% lidocaine solution containing 5µg/mL epinephrine was injected under the mucosa of the nasal septum immediately before the incision. Two minutes after this injection, the train of four ratio was significantly reduced. It took about 13 minutes to recover to the value recorded before the submucosal injection. Conclusion : Epinephrine increases the degree of muscle relaxation achieved by rocuronium, even when neuro-muscular function is recovering. Monitoring is the only mean to rule out a risk of postoperative residual curarization, given the numerous medications and factors interfering with the action of neuromuscular blocking agents.
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来源期刊
CiteScore
0.20
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0.00%
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2
期刊介绍: L’Acta Anaesthesiologica Belgica est le journal de la SBAR, publié 4 fois par an. L’Acta a été publié pour la première fois en 1950. Depuis 1973 l’Acta est publié dans la langue Anglaise, ce qui a été résulté à un rayonnement plus internationaux. Depuis lors l’Acta est devenu un journal à ne pas manquer dans le domaine d’Anesthésie Belge, offrant e.a. les textes du congrès annuel, les Research Meetings, … Vous en trouvez aussi les dates des Research Meetings, du congrès annuel et des autres réunions.
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