Tomita Asami, Satani Makoto, Suzuki Keitaro, Kaji Arito, Urushitani Shinji
Masui. 2016 Feb;65(2):179-83.
A 73-year-old woman with normal cardiac function underwent an elective total knee arthroplasty. After skin closure, levobupivacaine 225 mg was injected into the knee and 25 mg was injected subcutaneously. The patient recovered from general anesthesia 5 min after the surgery. Thirty five min after surgery, while in general radiology department her carotid arterial pulses were not palpable. Cardiopulmonary resuscitation (CPR) was initiated with intravenous (i.v.) administration of adrenaline 1 mg. Circulation was rapidly restored. Coronary angiography demonstrated no coronary stenosis; however, left ventriculography demonstrated takotsubo cardiomyopathy. The patient regained consciousness, but pulmonary edema and renal failure became worse. On postoperative day 2, continuous hemodialysis was instituted. Weaning from ventilatory support was completed on postoperative day 3; hemodialysis was stopped on day 14; and the patient left the intensive care unit on day 15. We believe cardiac arrest may have been precipitated by local anesthetic systemic toxicity (LAST), and administration of i. v. adrenaline 1 mg may have resulted in pulmonary edema. Patients should be carefully observed following local anesthetic with attention given to the side-effects of i. v. adrenaline.
一名心功能正常的73岁女性接受了择期全膝关节置换术。皮肤缝合后，向膝关节注射了225毫克左旋布比卡因，并皮下注射了25毫克。患者术后5分钟从全身麻醉中苏醒。术后35分钟，在普通放射科时，触不到她的颈动脉搏动。立即开始进行心肺复苏（CPR），静脉注射1毫克肾上腺素。循环迅速恢复。冠状动脉造影显示无冠状动脉狭窄；然而，左心室造影显示为应激性心肌病。患者恢复了意识，但肺水肿和肾衰竭加重。术后第2天，开始进行持续血液透析。术后第3天完成了撤机；第14天停止血液透析；患者于第15天离开重症监护病房。我们认为心脏骤停可能是由局部麻醉药全身毒性（LAST）引起的，静脉注射1毫克肾上腺素可能导致了肺水肿。局部麻醉后应仔细观察患者，并注意静脉注射肾上腺素的副作用。
