Maries H, Joyau F H
Service d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier, Sablé-sur-Sarthe.
Ann Fr Anesth Reanim. 1989;8(2):140-2. doi: 10.1016/s0750-7658(89)80168-6.
A case is reported of acute respiratory failure occurring during upper abdominal surgery in a patient not previously known to have chronic respiratory failure. Preoperatively, this 68 year old patient presented with mild obesity, slight effort dyspnoea and paralysis of the right hemidiaphragm, a sequela of polytrauma she suffered the year before. Respiratory tests were not considered useful with regard to the results of clinical examination. Moreover, she had already several previous general anaesthetics without any problems. A thoracic epidural anaesthesia was performed with a mixture of 150 mg lidocaine, 37.5 mg bupivacaine with adrenaline and 100 micrograms fentanyl, injected in the T8-T9 epidural space via a catheter. Ten minutes after the starting of surgery, the patient became agitated and complained of difficulty in breathing. Blood gas analysis showed hypercapnia, with respiratory acidosis (Pao2: 28.19 kPa; Paco2: 9.2 kPa; pH 7.273). Clinical examination revealed a bilateral Horner syndrome (T1-T4 sympathetic blockade). The patient was intubated and ventilated after adequate sedation. She was extubated 3 h 30 min after the initial epidural injection. Epidural analgesia was maintained during 72 h, with 0.1% bupivacaine, with no recurrence of respiratory failure.
报告了一例在上腹部手术期间发生急性呼吸衰竭的病例，该患者既往并无慢性呼吸衰竭病史。术前，这位68岁的患者表现为轻度肥胖、轻微劳力性呼吸困难以及右半膈肌麻痹，这是她前一年多发伤的后遗症。考虑到临床检查结果，呼吸测试被认为并无用处。此外，她此前已经接受过几次全身麻醉，均未出现任何问题。通过导管在T8 - T9硬膜外间隙注射了150毫克利多卡因、37.5毫克布比卡因加肾上腺素以及100微克芬太尼的混合液进行胸段硬膜外麻醉。手术开始十分钟后，患者变得烦躁不安，并诉说呼吸困难。血气分析显示高碳酸血症，伴有呼吸性酸中毒（动脉血氧分压：28.19千帕；动脉血二氧化碳分压：9.2千帕；pH值7.273）。临床检查发现双侧霍纳综合征（T1 - T4交感神经阻滞）。在充分镇静后对患者进行了插管和通气。在首次硬膜外注射后3小时30分钟拔除气管插管。使用0.1%布比卡因维持硬膜外镇痛72小时，未再出现呼吸衰竭。
