Bernard Philip A, McCabe Tara, Bayliff Sherry, Hayes Don
Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
J Oncol Pharm Pract. 2010 Dec;16(4):262-5. doi: 10.1177/1078155209360074. Epub 2010 Jan 29.
Neurotoxicity related to the use of ifosfamide is a well-known complication. While the use of methylene blue is a known antidote, symptomatic treatment of the central nervous system (CNS) effects can be challenging. We present a case of class IV neurotoxicity with the successful treatment of symptomology. In this case report we present a 2-year-old female with relapsed alveolar rhabdomyosarcoma undergoing palliative chemotherapy. Patient received ifosfamide in addition to etoposide and mesna. The patient developed acute hallucinations, agitation, and delirium. The patient was transferred to the pediatric intensive care unit where she was administered dexmedetomidine overnight in addition to methylene blue. The patient awoke the next morning following discontinuation of the dexmedetomidine infustion and subsequently had no further central nervous system effects. This case demonstrates the novel use of an alpha-2 agonist in the treatment of neurotoxicity related to ifosfamide administration.
与异环磷酰胺使用相关的神经毒性是一种众所周知的并发症。虽然亚甲蓝是已知的解毒剂，但对中枢神经系统（CNS）效应进行对症治疗可能具有挑战性。我们报告一例IV级神经毒性病例，其症状得到成功治疗。在本病例报告中，我们介绍一名2岁复发性肺泡横纹肌肉瘤女性患者，正在接受姑息化疗。患者除接受依托泊苷和美司钠外，还接受了异环磷酰胺治疗。患者出现急性幻觉、烦躁和谵妄。患者被转至儿科重症监护病房，除给予亚甲蓝外，还在夜间给予右美托咪定。在停止输注右美托咪定后的第二天早晨，患者醒来，随后未再出现中枢神经系统效应。本病例证明了α-2激动剂在治疗与异环磷酰胺给药相关的神经毒性中的新用途。
