Sakuta Yuka, Kuroda Naoko, Tsuge Masatsugu, Fujita Yoshihisa
Department of Anesthesiology & ICM, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
Student in the postgraduate course, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 7010192 Japan.
JA Clin Rep. 2015;1(1):13. doi: 10.1186/s40981-015-0014-5. Epub 2015 Sep 9.
Supraclavicular brachial plexus block is a common anesthetic technique performed for surgery of the upper extremities. We experienced a case of acute hypercapnic respiratory distress with loss of consciousness during creation of an arteriovenous fistula under ultrasound-guided supraclavicular brachial plexus block using 30 mL of 0.75 % ropivacaine. We detected ipsilateral hemidiaphragmatic paralysis by means of M-mode ultrasonography of the block. We thus speculate that phrenic nerve palsy caused by supraclavicular brachial plexus block was the underlying mechanism of the event. Bedside ultrasonography played a pivotal role in making a differential diagnosis and in managing this patient.
锁骨上臂丛神经阻滞是一种常用于上肢手术的麻醉技术。我们遇到一例在超声引导下锁骨上臂丛神经阻滞使用30毫升0.75%罗哌卡因进行动静脉造瘘术期间出现急性高碳酸血症性呼吸窘迫并伴有意识丧失的病例。我们通过对阻滞部位进行M型超声检查发现同侧半膈肌麻痹。因此，我们推测锁骨上臂丛神经阻滞引起的膈神经麻痹是该事件的潜在机制。床旁超声检查在鉴别诊断和该患者的管理中发挥了关键作用。
