Dun-Chi Lin Jonathan, Sivanesan Eellan, Horlocker Terese T, Missair Andres
From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; †Department of Anesthesiology, Jackson Memorial Hospital, Miami, Florida; ‡Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; and §Department of Anesthesiology, University of Miami, Miami, Florida.
A A Case Rep. 2017 May 1;8(9):235-237. doi: 10.1213/XAA.0000000000000477.
Combined spinal-epidural (CSE) analgesia is a frequently used method of labor analgesia. Although it is considered safe and effective, CSE can be complicated by local anesthetic systemic toxicity (LAST), a potentially life-threatening condition. We present a case of LAST that developed in a primigravida 50 minutes after uneventful placement of a CSE. Her symptoms resolved within 10 minutes of administering intralipid emulsion. She subsequently underwent cesarean delivery under spinal anesthesia for failure to progress without sequelae in the mother or infant. LAST in pregnancy can occur at traditionally subthreshold dosing; anesthesiologists must be vigilant to ensure prompt and effective treatment.
腰麻-硬膜外联合（CSE）镇痛是一种常用的分娩镇痛方法。尽管它被认为是安全有效的，但CSE可能会并发局部麻醉药全身毒性反应（LAST），这是一种潜在的危及生命的情况。我们报告一例初产妇在顺利置入CSE后50分钟发生LAST的病例。给予脂质乳剂后10分钟内她的症状得到缓解。随后她因产程无进展在脊麻下行剖宫产，母婴均无后遗症。孕期LAST可在传统阈下剂量时发生；麻醉医生必须保持警惕以确保及时有效的治疗。
