Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Pharmacother. 2010 Dec;44(12):2018-22. doi: 10.1345/aph.1P427. Epub 2010 Nov 9.
To describe the prolonged use of propofol for sedation of a critically ill pregnant patient in her second trimester.
A 20-year-old pregnant woman at 14 weeks' gestation with non-Hodgkin's lymphoma required intubation and mechanical ventilation secondary to tumor-related airway obstruction. Immediately after intubation, propofol was initiated for sedation and maintained for 51 days with only one 5-day interruption in therapy. Over the course of the patient's stay in the intensive care unit, systemic chemotherapy was administered, resulting in a reduction in tumor burden and allowing for successful extubation. Ultimately, the fetus was deemed nonviable and the pregnancy was terminated.
Propofol is an intravenous anesthetic agent commonly used for the sedation of mechanically ventilated patients and is the only sedative agent that carries a pregnancy category B rating. Fetal outcomes following long-term use of propofol during the first trimester have not been formally evaluated and few reports of propofol use outside of early pregnancy termination, outpatient procedures, or parturition exist in the medical literature. Our patient required early termination of pregnancy; however, we were unable to determine whether fetal loss was a result of propofol use, chemotherapy administration, the use of other pharmacologic agents, or perhaps a combined effect.
Despite propofol's pregnancy category B rating, data are lacking in humans regarding its safe use during pregnancy and long-term developmental outcomes in children after exposure to propofol in utero. The safety of propofol as a sedative agent for critically ill pregnant patients remains unknown.
描述一位妊娠中期危重症孕妇长时间使用异丙酚镇静的情况。
一位 20 岁的孕妇，妊娠 14 周，患有非霍奇金淋巴瘤，因肿瘤相关气道阻塞需要插管和机械通气。插管后立即开始使用异丙酚镇静，并持续使用了 51 天，仅中断治疗 5 天。在患者入住重症监护病房期间，给予了全身化疗，肿瘤负荷减少，成功拔管。最终，胎儿被认为无法存活，妊娠终止。
异丙酚是一种常用的静脉麻醉剂，用于机械通气患者的镇静，是唯一一种妊娠 B 类评级的镇静剂。在妊娠早期长期使用异丙酚后的胎儿结局尚未得到正式评估，在医学文献中，只有少数关于妊娠终止、门诊手术或分娩以外时期使用异丙酚的报道。我们的患者需要早期终止妊娠；然而，我们无法确定胎儿丢失是由于异丙酚的使用、化疗药物的使用、其他药物的使用，还是多种因素的综合作用。
尽管异丙酚的妊娠 B 类评级，但在人类中，关于其在妊娠期间的安全使用以及儿童在宫内接触异丙酚后的长期发育结局的数据仍然缺乏。异丙酚作为危重症孕妇镇静剂的安全性仍不清楚。
