Urabe K, Koguchi T, Ishikawa K, Sato H, Shinohara M, Okuda Y, Kitajima T, Isao T
First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi 321-0293.
Masui. 2001 Jan;50(1):50-2.
A 33 year-old man weighting, 93 kg with schizophrenia underwent repeated electroconvulsive therapy (ECT) under general anesthesia with thiamylal 200 mg and suxamethonium 80 mg. On his fourth ECT, he developed ventricular tachycardia (VT) immediately after the treatment under general anesthesia with the same agents. The duration of VT was approximately 30 s. The VT returned to sinus rhythm without any special treatment. We speculate that light anesthesia with a small amount of thiopental associated with release of serum potassium caused by suxamethonium induced increased release of catecholamine by ECT to cause VT. After that incident, the patient underwent ECT six times under general anesthesia with thiamylal 250 mg and vecuronium 8 mg, in combination with preventive injection of magnesium sulfate 20 g without any cardiovascular complications. We conclude that the anesthetic management of patients undergoing ECT under general anesthesia should be paid a careful attention for cardiovascular instability, even if they do not have any heart diseases.
一名33岁、体重93公斤的精神分裂症男性患者，在使用200毫克硫喷妥钠和80毫克琥珀酰胆碱进行全身麻醉的情况下接受重复电休克治疗（ECT）。在他第四次接受ECT时，在使用相同药物进行全身麻醉治疗后立即出现室性心动过速（VT）。VT持续时间约为30秒。VT未经任何特殊治疗即恢复为窦性心律。我们推测，少量硫喷妥钠导致的浅麻醉与琥珀酰胆碱引起的血清钾释放相关，ECT诱导儿茶酚胺释放增加从而导致VT。那次事件之后，该患者在使用250毫克硫喷妥钠和8毫克维库溴铵进行全身麻醉的情况下又接受了6次ECT，同时预防性注射20克硫酸镁，未出现任何心血管并发症。我们得出结论，即使患者没有任何心脏病，在全身麻醉下接受ECT患者的麻醉管理也应密切关注心血管不稳定情况。
