Dragan Kristen Elizabeth, Patten William D, Elzamzamy Osama M, Attaallah Ahmed Fikry
Department of Anesthesiology, West Virginia University, School of Medicine, 1 Medical Center, PO Box 8255, Morgantown, WV, 26506, USA.
Department of Pediatrics, Section of Critical Care Medicine, West Virginia University, Morgantown, WV, USA.
J Anesth. 2016 Feb;30(1):152-5. doi: 10.1007/s00540-015-2071-3. Epub 2015 Aug 28.
Neurogenic stunned myocardium (NSM) is syndrome of myocardial dysfunction following an acute neurological insult. We report a case of NSM that occurred intraoperatively in a pediatric patient undergoing endoscopic fenestration and shunt revision. Accidental outflow occlusion of irrigation fluid and ventricular distension resulted in an acute increase in heart rate and arterial blood pressure. Subsequently, the patient developed stunned myocardium with global myocardial hypokinesia and pulmonary edema. She was promptly treated intraoperatively then admitted to the pediatric intensive care unit with resolution of her symptoms within 12 h. She was later discharged to home on the fourth postoperative day. In the current endoscopic era, this report highlights the possibility of intraoperative NSM and neurogenic pulmonary edema in the pediatric population. Early detection and treatment with a team approach help to achieve optimal control of this life-threatening condition and improve the outcome.
神经源性休克心肌（NSM）是急性神经损伤后出现的心肌功能障碍综合征。我们报告了一例在接受内镜开窗和分流修复术的儿科患者术中发生的NSM病例。冲洗液意外流出受阻和心室扩张导致心率和动脉血压急性升高。随后，患者出现心肌顿抑，伴有全心运动减弱和肺水肿。术中对她进行了及时治疗，然后收入儿科重症监护病房，症状在12小时内得到缓解。她于术后第四天出院回家。在当前的内镜时代，本报告强调了儿科患者术中发生NSM和神经源性肺水肿的可能性。采用团队方法进行早期检测和治疗有助于实现对这种危及生命状况的最佳控制并改善预后。
