Marco J, Mohamed-Mabrok M, Battich I, Torres J, Moral V
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de Sabadell, Barcelona.
Rev Esp Anestesiol Reanim. 1992 Mar-Apr;39(2):123-5.
We report the case of a premature newborn child (36 weeks) who was operated on a teratoma of the sacrum when he was 12 days old and weighed 2,950 g. The patient presented a late postoperative apnea 17 hours after anesthesia. The anesthetic technique consisted of lumbar epidural blockade with 0.33% bupivacaine at a dose of 2.25 ml and superficial inhalation anesthesia with 0.5% isoflurane. Relaxing muscular agents used in this case were succinylcholine (3 mg) for orotracheal intubation and pancuronium bromide (0.3 mg) for maintaining the anesthetic level. The immediate postoperative phase was uneventful but 17 hours after surgery the patient presented apnea, bradycardia (40 beats/min), and marked cyanosis requiring assisted ventilation with bag and mask during 3 min and initial cardiac massage. Recovery of heart rate was immediate and recovery of ventilation was progressive. The patient was treated with caffeine during one week and no relapses occurred. Pneumocardiographic recordings obtained later on revealed sporadic short lasting episodes of apnea (shorter than 15 s) sometimes associated with bradycardia (40 beats/min lower than baseline). There were no apparent intercurrent or precipitating factors for this apnea. We believe that the present clinical picture corresponds to a late postoperative apnea of unknown origin which required reanimation measures and that until present, there are no reported complications of the anesthetic technique that can explain this episode.
我们报告了一例早产新生儿（36周）的病例，该患儿在出生12天、体重2950克时接受了骶骨畸胎瘤手术。患者在麻醉后17小时出现术后迟发性呼吸暂停。麻醉技术包括用0.33%布比卡因2.25毫升进行腰段硬膜外阻滞以及用0.5%异氟醚进行浅度吸入麻醉。该病例中用于气管插管的肌肉松弛剂是琥珀酰胆碱（3毫克），用于维持麻醉水平的是潘库溴铵（0.3毫克）。术后即刻阶段平稳，但术后17小时患者出现呼吸暂停、心动过缓（40次/分钟）和明显发绀，需要用面罩气囊辅助通气3分钟并进行初步心脏按摩。心率立即恢复，通气逐渐恢复。患者接受了一周的咖啡因治疗，未再复发。后来获得的肺心动图记录显示有偶发的短暂呼吸暂停发作（短于15秒），有时伴有心动过缓（比基线低40次/分钟）。此次呼吸暂停没有明显的并发或诱发因素。我们认为目前的临床表现符合不明原因的术后迟发性呼吸暂停，需要复苏措施，并且截至目前，尚无报告的麻醉技术并发症能够解释这一情况。
