Tabuchi Yachiyo
Division of Anesthesia, Shinko-Kakogawa Hospital, Kakogawa 675-0115.
Masui. 2007 Dec;56(12):1429-32.
We report a case of accidental epidural injection of vecuronium during cholecystectomy in a 55-year-old man (63 kg, 158 cm). Following 3 ml of lidocaine 1% as an epidural test dose, inadvertent epidural (T7-8) injection of vecuronium 4.25 mg instead of ropivacaine occurred. After immediate removal of the syringe containing vecuronium, 10 ml of ropivacaine 0.375% was injected epidurally. Intubation was performed under propofol infusion using a target-controlled infusion system with intravenous vecuronium 10 mg. There was a 3 min interval between inadvertent epidural and intravenous injection of vecuronium. Anesthesia was maintained with propofol infusion (2.6-3.0 microg x ml(-1)) titrated to maintain bispectral index between 35-55 and buprenorphine 0.16 mg with 40% oxygen in air. T1 response in the train-of-four (TOF) appeared 87 min after epidural vecuronium injection. Ten minutes later, additional vecuronium 0.5mg was required due to bucking. Seven minutes after that, T1 in the TOF reappeared and the operation was finished. Twenty-three minutes after the additional vecuronium, 4 responses in the TOF were obtained. Following reversal with atropine 1.0 mg and neostigmine 2.0 mg, the patient was able to sustain head lift and handgrip, and to protrude the tongue fully awake. The patient was extubated 124 min after epidural vecuronium injection. There was no memory of back pain during epidural vecuronium injection. There was no postoperative respiratory insufficiency or neurological disorder. We suspect the duration of action of epidural vecuronium is approximately twice that of intravenous injection and becomes prolonged with higher doses and advanced age.
我们报告一例55岁男性（体重63kg，身高158cm）在胆囊切除术中意外硬膜外注射维库溴铵的病例。在给予3ml 1%利多卡因作为硬膜外试验剂量后，误将4.25mg维库溴铵而非罗哌卡因注入硬膜外（T7 - 8）。立即移除装有维库溴铵的注射器后，硬膜外注入10ml 0.375%罗哌卡因。在丙泊酚输注下，使用静脉注射维库溴铵10mg的靶控输注系统进行气管插管。硬膜外误注维库溴铵与静脉注射维库溴铵之间间隔3分钟。通过丙泊酚输注（2.6 - 3.0μg·ml⁻¹）维持麻醉，滴定以维持脑电双频指数在35 - 55之间，并给予丁丙诺啡0.16mg，吸入40%氧气与空气的混合气体。硬膜外注射维库溴铵87分钟后，四个成串刺激（TOF）中的T1反应出现。10分钟后，由于呛咳需要追加维库溴铵0.5mg。此后7分钟，TOF中的T1反应再次出现，手术结束。追加维库溴铵23分钟后，TOF中出现4次反应。用1.0mg阿托品和2.0mg新斯的明拮抗后，患者能够抬头、握力良好，完全清醒时能充分伸舌。硬膜外注射维库溴铵124分钟后患者拔除气管导管。患者对硬膜外注射维库溴铵期间的背痛无记忆。术后无呼吸功能不全或神经功能障碍。我们怀疑硬膜外注射维库溴铵的作用持续时间约为静脉注射的两倍，且随着剂量增加和年龄增长而延长。
