Department of Anesthesiology, Osaka Dental University, Osaka, Japan.
First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan.
Anesth Prog. 2020 Dec 1;67(4):226-229. doi: 10.2344/anpr-67-02-10.
Restless legs syndrome (RLS) is a neurological sensory disorder associated with sensory and motor symptoms that most commonly occur at night and during periods of rest. It is characterized by altered or abnormal sensations primarily in the legs and the urge to move the associated limbs. Perioperative procedures, including general anesthesia, can cause exacerbations of RLS. This is a case report of a suspected RLS exacerbation in a 22-year-old woman who had no formal diagnosis of RLS despite reporting symptoms that met all essential diagnostic criteria by the International RLS Study Group. Despite her previous diagnoses of dehydration induced-muscle pain or nocturnal cramps, we suspected her to have RLS. The patient underwent general anesthesia for a bilateral sagittal split ramus osteotomy using a combined inhalational and intravenous anesthetic technique with sevoflurane, propofol, remifentanil, and dexmedetomidine. After successful completion of the surgery and returning to the ward, she began moving her lower extremities and complaining of unpleasant sensations in both ankles. Bed rest exacerbated the suspected RLS symptoms despite a continuous infusion of dexmedetomidine. The RLS symptoms continued to worsen and spread to her upper extremities. After increasing the dexmedetomidine infusion from 0.2 to 0.4 μg/kg/h, almost all symptoms improved, and she slept for 3 hours. Upon awakening, the unpleasant sensations were completely relieved by walking and stretching. The patient was formally diagnosed with RLS by a neurologist after discharge. In this case, an infusion of dexmedetomidine was helpful in successfully managing a suspected exacerbation of RLS.
不宁腿综合征（RLS）是一种与感觉和运动症状相关的神经系统感觉障碍，这些症状通常在夜间和休息期间发生。其特征是腿部感觉改变或异常，并伴有移动相关肢体的强烈冲动。包括全身麻醉在内的围手术期操作会导致 RLS 恶化。这是一名 22 岁女性疑似 RLS 恶化的病例报告，尽管她报告的症状符合国际 RLS 研究组的所有基本诊断标准，但她没有正式的 RLS 诊断。尽管她之前被诊断为脱水引起的肌肉疼痛或夜间抽筋，但我们怀疑她患有 RLS。该患者因双侧矢状劈开下颌骨切开术接受全身麻醉，采用七氟醚、异丙酚、瑞芬太尼和右美托咪定联合吸入和静脉麻醉技术。手术成功完成并返回病房后，她开始移动下肢，并抱怨两个脚踝处有不愉快的感觉。尽管持续输注右美托咪定，但卧床休息加重了疑似 RLS 症状。RLS 症状继续恶化并扩散到上肢。将右美托咪定输注量从 0.2 增加到 0.4 μg/kg/h 后，几乎所有症状均得到改善，她睡了 3 个小时。醒来后，走动和伸展完全缓解了不愉快的感觉。患者出院后由神经科医生正式诊断为 RLS。在这种情况下，右美托咪定输注有助于成功管理疑似 RLS 恶化。
