Ahuja Vanita, Chander Anjuman, Sawal Nishit
Associate Professor, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital Sector 32, Chandigarh, India.
Junior Resident, Department of Anaesthesia and Intensive Care, Government Medical College and Hospital Sector 32, Chandigarh, India.
Trop Doct. 2020 Jul;50(3):238-239. doi: 10.1177/0049475519896942. Epub 2020 Jan 6.
A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.
一名30岁女性因5小时前被蛇咬伤前来急诊，伴有延髓麻痹、上睑下垂、呼吸窘迫及四肢无力症状。立即进行了机械通气、注射抗蛇毒血清（ASV）及支持治疗。在注射第三剂ASV后，出现了早期过敏反应。随后在接下来的几天里使用皮质类固醇和抗组胺药进行治疗，患者意识恢复，但肌力未超过2/5级。然而，静脉注射新斯的明加格隆溴铵试验使四肢肌力提高到3/5级。随后每8小时口服60毫克溴吡斯的明，使四肢运动功能完全恢复。我们建议在对ASV发生过敏反应后考虑使用溴吡斯的明来促进运动功能恢复。
