一例因术中进行性低钠血症导致清醒开颅手术失败的病例。
A case of failed awake craniotomy due to progressive intraoperative hyponatremia.
作者信息
Yamamoto Suguru, Masaki Hanayo, Kamata Kotoe, Nomura Minoru, Ozaki Makoto
机构信息
Department of Anesthesiology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
出版信息
JA Clin Rep. 2018 May 15;4(1):40. doi: 10.1186/s40981-018-0176-z.
BACKGROUND
Perioperative seizure control is correlated with a better surgical outcome for awake craniotomy, but some anticonvulsants can induce hyponatremia. Mannitol has also been reported to be hyponatremic.
CASE PRESENTATION
A 51-year-old right-handed man had malignant glioma in the left parietal lobe. Since anticonvulsant polytherapy did not stop his seizure activity, the daily dose of carbamazepine was increased beginning 17 days before awake craniotomy. The last preoperative blood examination indicated that his plasma sodium level had gradually decreased from 140 to 130 mEq/L. Following skin incision, 200 mL of 20% mannitol was administered and his plasma sodium level subsequently dropped to 117 mEq/L. The surgical strategy was changed so that the entire procedure would be performed under general anesthesia because severe intraoperative complications were anticipated.
CONCLUSIONS
This case suggests that a perioperative electrolyte imbalance caused by drug interactions could be clinically significant for awake craniotomy.
背景
围手术期癫痫控制与清醒开颅手术更好的手术结果相关，但一些抗惊厥药物可诱发低钠血症。据报道甘露醇也会导致低钠血症。
病例报告
一名51岁右利手男性，左顶叶患有恶性胶质瘤。由于联合使用抗惊厥药物未能控制其癫痫发作，在清醒开颅手术前17天开始增加卡马西平的每日剂量。术前最后一次血液检查显示，他的血浆钠水平已从140mEq/L逐渐降至130mEq/L。皮肤切开后，给予200mL 20%的甘露醇，随后其血浆钠水平降至117mEq/L。由于预计会出现严重的术中并发症，因此改变了手术策略，以便在全身麻醉下进行整个手术过程。
结论
该病例表明，药物相互作用引起的围手术期电解质失衡对清醒开颅手术可能具有临床意义。
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