Takeguchi Yumi, Miyamoto Yoshihisa, Sone Tetsuhiro, Kato Hiroko
Department of Anesthesia, Kobe City General Hospital, Kobe 650-0046.
Masui. 2003 Mar;52(3):284-7.
A 71-year-old woman on chronic therapy with mianserine and amantadine was scheduled to undergo abdominal hysterectomy under spinal anesthesia. Following spinal anesthesia she developed hypotension refractory to continuous intravenous fluid infusion as well as multiple boluses of ephedrine. Because the maximum level of analgesia was T 8, general anesthesia was added using laryngeal mask airway. Immediately after anesthetic induction, a marked hypotension occurred. Blood pressure again did not respond to ephedrine but went up excessively to a small dose of epinephrine without any changes in heart rate. Epinephrine infusion at a low dose rate was needed to sustain the blood pressure during surgery. Both depletion of presynaptic norepinephrine store and down-regulation of postsynaptic beta-receptor may have led to abnormal response to catecholamines in this case.
一名71岁长期服用米安色林和金刚烷胺的女性计划在脊髓麻醉下接受腹部子宫切除术。脊髓麻醉后，她出现了对持续静脉输液以及多次麻黄碱推注均无反应的低血压。由于镇痛的最高平面为T8，遂加用喉罩气道全身麻醉。麻醉诱导后立即出现明显低血压。血压再次对麻黄碱无反应，但对小剂量肾上腺素反应过度，心率无变化。手术期间需要以低剂量速率输注肾上腺素来维持血压。在这种情况下，突触前去甲肾上腺素储备的耗竭和突触后β受体的下调可能导致了对儿茶酚胺的异常反应。
