通过联合使用瑞芬太尼对先天性无痛觉伴无汗症患者进行麻醉管理。
Anesthetic management of a patient with congenital insensitivity to pain with anhidrosis by coadministration of remifentanil.
作者信息
Takeuchi Yoko, Fujita Yoshihito, Shimomura Takeshi, Kurokawa Shuji, Noguchi Hiroki, Fujiwara Yoshihiro
机构信息
Department of Anesthesiology, Aichi Medical University School of Medicine, 1-1 Yazako Karimata, Nagakute, Aichi, 480-1195, Japan.
Department of Anesthesiology, JA Aichikoseiren Konan Kosei Hospital, 137 Oomatubara Takaya, Konan, Aichi, Japan.
出版信息
JA Clin Rep. 2018 Oct 3;4(1):72. doi: 10.1186/s40981-018-0208-8.
BACKGROUND
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease characterized by unexplained fever, systemic insensitivity to pain, anhidrosis, and mental distress. Anesthetic management is challenging because autonomic dysfunction can induce perioperative complications. Only a few reports of anesthetic management of CIPA patients have been published. We herein present a case of successful management of the same patient on two occasions using small doses of fentanyl and remifentanil.
CASE PRESENTATION
A 37-year-old man with CIPA underwent two orthopedic operations. We were able to balance the dose of remifentanil to avoid the extremes of hyperalgesia when the dose is too low and shivering when the dose is too high.
CONCLUSION
To our knowledge, no reports have described the anesthetic management of CIPA patients with remifentanil. We consider anesthetic management with coadministration of remifentanil to be potentially useful for such patients.
背景
先天性无痛觉伴无汗症（CIPA）是一种罕见的常染色体隐性疾病，其特征为不明原因发热、全身性痛觉缺失、无汗及精神困扰。麻醉管理具有挑战性，因为自主神经功能障碍可诱发围手术期并发症。关于CIPA患者麻醉管理的报道仅有少数几例。我们在此介绍同一例患者两次使用小剂量芬太尼和瑞芬太尼成功进行麻醉管理的病例。
病例介绍
一名37岁的CIPA男性患者接受了两次骨科手术。我们能够平衡瑞芬太尼的剂量，避免剂量过低时出现痛觉过敏以及剂量过高时出现寒战。
结论
据我们所知，尚无关于使用瑞芬太尼对CIPA患者进行麻醉管理的报道。我们认为联合使用瑞芬太尼进行麻醉管理对此类患者可能有用。
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