Gries A, Motsch J, Ulmer H E, Springer W
Klinik für Anaesthesiologie der Universität Heidelberg.
Anaesthesist. 2003 Feb;52(2):127-31. doi: 10.1007/s00101-002-0434-2.
Postoperative laryngospasm during emergence from anaesthesia represents a potentially life-threatening complication. Even if this is successfully overcome using drug therapy, new, serious problems may develop. We report the case of a 3 1/2 -year-old boy of African descent weighing 15 kg who developed a laryngospasm during emergence from anaesthesia. Because the airway obstruction could not be controlled by deepening the anaesthesia again and administering anti-obstructive drugs, the boy was given 15 mg succinylcholine. Thereafter prolonged apnea developed such that the patient had to be admitted to the pediatric intensive care unit. The child was extubated 6 h later and the further course was normal so that he could be released from the hospital the following day. Further diagnostic study revealed a dibucaine-sensitive, fluoride-resistant pseudocholinesterase in the plasma, which is a rare form of atypical pseudocholinesterase, explaining the prolonged arousal phase after the administration of succinylcholine. Three significant aspects of this case are discussed: 1. risk factors and treatment of perioperative airway obstruction 2. factors and treatment of prolonged apnea, and 3. delayed arousal reactions and their management in an outpatient setting.
麻醉苏醒期发生的术后喉痉挛是一种潜在的危及生命的并发症。即使通过药物治疗成功克服了这一问题，也可能会出现新的严重问题。我们报告一例3岁半、体重15kg的非洲裔男孩，在麻醉苏醒期发生喉痉挛。由于再次加深麻醉和使用抗梗阻药物无法控制气道梗阻，遂给该男孩静脉注射15mg琥珀酰胆碱。此后出现了长时间的呼吸暂停，患儿不得不入住儿科重症监护病房。6小时后患儿拔除气管导管，后续病程正常，次日出院。进一步的诊断研究显示，患儿血浆中存在一种对丁卡因敏感、对氟化物耐药的假性胆碱酯酶，这是一种罕见的非典型假性胆碱酯酶形式，解释了注射琥珀酰胆碱后出现长时间苏醒期的原因。本文讨论了该病例的三个重要方面：1. 围手术期气道梗阻的危险因素及治疗；2. 长时间呼吸暂停的因素及治疗；3. 门诊环境下延迟苏醒反应及其处理。
