Funk W, Wollschläger H
Klinik für Anästhesiologie, Klinikum St. Marien, Mariahilfbergweg 7, 92224, Amberg.
Anaesthesist. 2006 Jul;55(7):769-72. doi: 10.1007/s00101-006-1025-4.
Prior to anesthesia a 65-year-old patient received 8 mg dexamethasone to prevent postoperative nausea and vomiting (PONV). Instantly she reported tingling and burning followed by intense pain in the genital region spreading to the whole body. Shortly later she complained about shortness of breath and pre-cordial pain. Acute hypertension could only be lowered by NTG, beta-blockade and induction of anesthesia. The ECG showed ST-segment depressions and troponin-T was elevated (0.3 ng/ml). Coronary angiography revealed no significant stenosis and an abdominal CT scan showed no evidence of a pheochromocytoma. Urine metabolites of catecholamines were negative. Thus, the most likely diagnosis was stimulation of endogenous catecholamines by painful stress after dexamethasone injection with the consequence of myocardial ischemia. As a result we now routinely inject dexamethasone after anesthesia induction as prophylaxis for PONV.
麻醉前，一名65岁患者接受了8毫克地塞米松以预防术后恶心和呕吐（PONV）。随即她报告生殖器区域有刺痛和烧灼感，随后疼痛加剧并蔓延至全身。不久后，她又抱怨呼吸急促和心前区疼痛。急性高血压只能通过硝酸甘油、β受体阻滞剂和诱导麻醉来降低。心电图显示ST段压低，肌钙蛋白T升高（0.3纳克/毫升）。冠状动脉造影显示无明显狭窄，腹部CT扫描未发现嗜铬细胞瘤的迹象。儿茶酚胺的尿代谢产物为阴性。因此，最可能的诊断是地塞米松注射后疼痛应激刺激内源性儿茶酚胺，导致心肌缺血。结果，我们现在常规在麻醉诱导后注射地塞米松以预防PONV。
