Castillo-Zamora Carlos, Castillo-Peralta Luz A, Nava-Ocampo Alejandro A
Department of Anesthesiology, Instituto Nacional de Rehabilitación, México DF, México.
Ther Drug Monit. 2006 Jun;28(3):458-62. doi: 10.1097/01.ftd.0000196661.97607.d4.
Ketorolac is a potent analgesic drug that has been restricted in dosage and use because of its potential adverse effects. The diagnostic and ethical challenges of 2 children who had unpredictable adverse drug reactions to ketorolac are reported. Case 1: A 3-year-old boy received ketorolac 1 mg/kg for prevention of postoperative pain at the end of an orthopedic surgical procedure. Ten minutes later, he had bilateral palpebral edema, erythema in thorax, hypotension, and tachycardia. The adverse event was classified as a mixed reaction probably related to ketorolac. Case 2: A 7-year-old girl, who had previously received ketorolac in 2 different surgical procedures, underwent a third orthopedic surgery. She received ketorolac 1 mg/kg as pre-emptive analgesia at 1.5 hours of anesthetic time (approximately 1 hour of surgical time). The patient developed palpebral edema 5 minutes later in addition to erythema in thorax, hypotension, tachycardia, tachypnea, oxygen desaturation, and wheezing. The adverse event was classified as a systemic reaction probably related to ketorolac. The 2 patients were successfully treated with symptomatic therapy. Although rare in its frequency, ketorolac administration may be associated to anaphylactic and anaphylactoid reactions in children with or without history of previous exposure. Because ketorolac is off-licensed for pediatric patients, it should be administered only after the risks and benefits have been discussed with the child's parents in the preanesthetic consultation.
酮咯酸是一种强效镇痛药，因其潜在的不良反应而在剂量和使用上受到限制。本文报告了2例对酮咯酸发生不可预测药物不良反应的儿童的诊断及伦理挑战。病例1：一名3岁男孩在骨科手术结束时接受1 mg/kg酮咯酸以预防术后疼痛。10分钟后，他出现双侧睑水肿、胸部红斑、低血压和心动过速。该不良事件被归类为可能与酮咯酸有关的混合反应。病例2：一名7岁女孩曾在2次不同的手术中接受过酮咯酸治疗，此次接受第三次骨科手术。在麻醉时间1.5小时（约手术时间1小时）时，她接受1 mg/kg酮咯酸作为超前镇痛。5分钟后，患者除出现胸部红斑、低血压、心动过速、呼吸急促、氧饱和度下降和喘息外，还出现睑水肿。该不良事件被归类为可能与酮咯酸有关的全身反应。这2例患者经对症治疗后均获成功。尽管酮咯酸不良反应的发生率较低，但无论既往有无接触史，儿童使用酮咯酸都可能发生过敏反应和类过敏反应。由于酮咯酸未获儿科患者许可，因此只有在麻醉前咨询中与患儿家长讨论风险和益处后，才可使用。
