Barbier P, Jonville A P, Autret E, Coureau C
Department of Pharmaco-Toxicovigilance, Hôpital Bretonneau, Tours, France.
Drug Saf. 1992 Jan-Feb;7(1):71-3. doi: 10.2165/00002018-199207010-00008.
Epidural analgesia for caesarean section is increasingly used and is gradually replacing general anaesthesia. Hypotension is one of the main risks: preloading of the maternal circulation is used to prevent maternal hypotension and its consequences. For this, various colloid and crystalloid solutions are used. We report a case of maternal anaphylactoid reaction with apparent death in a neonate after dextran administration to the mother. After 100ml of a dextran 40 solution administered intravenously, immediately before an epidural blockade, the mother fainted and developed urticaria and mild respiratory disturbances, without hypotension. At that point dextran infusion was stopped. An apparently dead neonate was rapidly delivered. Immediate and vigorous cardiopulmonary resuscitation was successful. Clonismus appeared 12h later, followed by 3 general epileptic fits treated by phenytoin infusion and subsequently oral phenobarbital. No aetiology was found. After 2 months of treatment, barbiturates were stopped following clinical and electroencephalogram (EEG) improvement. Several similar cases of neonatal disorders resulting from preventive dextran administration during delivery were studied in a national pharmacovigilance survey in France. There were 32 cases reported with moderate maternal anaphylactoid reaction associated with severe acute fetal distress; it is probably advisable to take a cautious approach and avoid preventive fluid preload by dextran administration. Gelatins or crystalloid solutions should be preferred, with intravenous vasopressive amine administered promptly and repeated if necessary should significant maternal hypotension occur during epidural anaesthesia.
剖宫产硬膜外镇痛的应用越来越广泛，并逐渐取代全身麻醉。低血压是主要风险之一：通过对母体循环进行预充来预防母体低血压及其后果。为此，使用了各种胶体溶液和晶体溶液。我们报告了一例产妇在接受右旋糖酐治疗后发生类过敏反应，新生儿出现明显死亡的病例。在硬膜外阻滞前即刻静脉注射100ml右旋糖酐40溶液后，产妇昏厥，出现荨麻疹和轻度呼吸紊乱，但无低血压。此时停止输注右旋糖酐。迅速娩出一名看似死亡的新生儿。立即进行积极的心肺复苏成功。12小时后出现阵挛，随后发生3次全身性癫痫发作，通过静脉输注苯妥英钠治疗，随后口服苯巴比妥。未发现病因。经过2个月的治疗，随着临床症状和脑电图（EEG）改善，停用巴比妥类药物。在法国的一项国家药物警戒调查中，研究了几例分娩期间预防性使用右旋糖酐导致新生儿疾病的类似病例。报告了32例产妇中度类过敏反应伴有严重急性胎儿窘迫的病例；谨慎行事并避免通过使用右旋糖酐进行预防性液体预充可能是明智的。应优先选择明胶或晶体溶液，在硬膜外麻醉期间如果产妇出现明显低血压，应立即静脉注射血管活性胺，并在必要时重复使用。
