腰椎手术后全身麻醉苏醒期癫痫发作的病例报告——常见病例可能会发生潜在危及生命的颅内不良事件。
A case report of seizure during emergence from general anesthesia after lumbar spinal surgery-common cases can develop potentially life-threatening adverse intracranial events.
作者信息
Matsuhiro Junko, Kariyazono Rumi, Mizutani Koh, Hinotsume Akinori, Tsuchiya Masahiko
机构信息
Department of Anesthesia, Osaka Rosai Hospital, 1179-3, Nagasonecho, Kita-ku, Sakai, 591-8025, Japan.
Department of Anesthesia, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan.
出版信息
JA Clin Rep. 2018 May 25;4(1):42. doi: 10.1186/s40981-018-0179-9.
BACKGROUND
Adverse intracranial events after spinal surgery were related with intracranial hypotension due to surgical injury of dura mater.
CASE PRESENTATION
A 72-year-old woman received posterior lumbar interbody fusion under general anesthesia. Immediately after the patient was transitioned to the supine position and muscular relaxants were reversed, she developed generalized seizure. The seizure was immediately suppressed with propofol. Brain computed tomography was unremarkable. Although she returned to the surgical suite, an evident point of dural laceration was not found. The dura was covered with fibrin glue. Magnetic resonance imaging revealed subarachnoid hemorrhage (SAH) on postoperative day 1. By postoperative day 2, the seizure had resolved. The cause of her seizure was suspected to be SAH due to intracranial hypotension. Seizure was masked by ongoing anesthesia and muscle relaxation.
CONCLUSIONS
Although spinal surgeries are common procedure, we must carefully consider its related potentially life-threatening adverse events.
背景
脊柱手术后的颅内不良事件与硬脊膜手术损伤导致的颅内低压有关。
病例报告
一名72岁女性在全身麻醉下接受了后路腰椎椎间融合术。患者转为仰卧位并停用肌肉松弛剂后立即出现全身性癫痫发作。丙泊酚立即抑制了癫痫发作。脑部计算机断层扫描无异常。尽管她返回了手术室，但未发现明显的硬脊膜撕裂点。硬脊膜用纤维蛋白胶覆盖。术后第1天磁共振成像显示蛛网膜下腔出血（SAH）。到术后第2天，癫痫发作已缓解。怀疑她癫痫发作的原因是颅内低压导致的SAH。癫痫发作被持续的麻醉和肌肉松弛所掩盖。
结论
尽管脊柱手术是常见的手术，但我们必须仔细考虑其相关的潜在危及生命的不良事件。
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