Shin Yoshiaki, Ono Daisuke, Watanabe Yoko, Ishii Mizue, Iwasaki Etsu, Kobayashi Hiroyuki, Fukushima Tomihiro, Tokioka Hiroaki
Department of Anesthesiology, Okayama Red Cross General Hospital, Okayama 700-8607.
Masui. 2013 Apr;62(4):453-7.
We report a case of an 85-year-old woman with delayed awakening from general anesthesia caused by psychological unresponsiveness. She underwent an open reduction of the right femoral bone fracture. Induction of general anesthesia was done with fentanyl, propofol, sevoflurane, and rocuronium. Anesthesia was maintained with sevoflurane and remifentanil without any incidents. After the operation she opened her eyes and tried to extubate the endtracheal tube and then she was extubated. She developed coma and did not respond to painful stimuli after extubation, but spontaneous breathing was maintained with stable hemodynamics. Although naloxone was given, she was still comatose. Her clinical neurological findings and the brain CT scan showed no organic abnormalities. The bispectral index showed the value of 85 to 95; 2.5 hrs after operation she moved her extremities in response to pain and 3.5 hrs after operation she gradually woke up and obeyed commands. After fully awakening she showed no clinical manifestations of psychological abnormality during her postoperative period and no sequela.
我们报告一例85岁女性因心理无反应导致全身麻醉后苏醒延迟的病例。她接受了右侧股骨骨折切开复位术。全身麻醉诱导采用芬太尼、丙泊酚、七氟醚和罗库溴铵。麻醉维持采用七氟醚和瑞芬太尼，未发生任何意外。术后她睁开眼睛并试图拔除气管内导管，随后进行了拔管。拔管后她陷入昏迷，对疼痛刺激无反应，但自主呼吸得以维持，血流动力学稳定。尽管给予了纳洛酮，她仍处于昏迷状态。她的临床神经学检查结果和脑部CT扫描均未显示器质性异常。脑电双频指数显示值为85至95；术后2.5小时她因疼痛而活动四肢，术后3.5小时她逐渐苏醒并能听从指令。完全苏醒后，她在术后期间未表现出心理异常的临床表现，也无后遗症。
