Calleja-Alarcón Salvador, Sánchez-Hurtado Luis Alejandro, Romero-Gutiérrez Laura, Guerrero-Escobar Juan Carlos, Ávila-García Juan Emmanuel
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Cuidados Intensivos. Ciudad de México, México.
Rev Med Inst Mex Seguro Soc. 2022 May 2;60(3):356-360.
Ketamine is used in intravenous anesthesia for the maintenance in the general anesthesia. It has characteristics to prevent the difficult of breathing due to bronchospasm, as well as the delivery of histamine associated with asthmatic attack. These effects come from the direct action in the bronchial muscle, as well as from the potentiation of its catecholamines, which is why its use is very controversial, given that there are not enough trials to back it up. Moreover, the effect of ketamine on bronchospasm due to anaphylactic reaction has not been studied. The election treatment is epinephrine and there are factors associated with its use. The objective was to present the case of a patient with a history of allergic reaction to midazolam, who presented bronchospasm due to the administration of this drug, and who received unconventional treatment with positive outcomes.
We present the case of a young female with a history of allergies to medicines, specifically to benzodiazepines, who presented bronchospasm and oxygen saturation drop after receiving a dose of midazolam into her eye while she was working. The use of ketamine was proposed after adrenaline, a beta-agonist, inhaled anticholinergics, a steroid and antihistamine drugs were used.
Trials are needed in order to demonstrate the efficacy of ketamine in this particular context; however, the outcome in this case was positive.
氯胺酮用于静脉麻醉以维持全身麻醉。它具有防止因支气管痉挛导致呼吸困难以及与哮喘发作相关的组胺释放的特性。这些作用源于其对支气管肌肉的直接作用，以及对儿茶酚胺的增强作用，鉴于缺乏足够的试验支持，其使用存在很大争议。此外，氯胺酮对过敏反应引起的支气管痉挛的作用尚未得到研究。首选治疗药物是肾上腺素，且其使用存在相关影响因素。目的是介绍一名有咪达唑仑过敏史的患者的病例，该患者因使用此药出现支气管痉挛，并接受非常规治疗且取得了积极效果。
我们介绍一名有药物过敏史，特别是对苯二氮䓬类药物过敏的年轻女性病例，她在工作时眼部滴入一剂咪达唑仑后出现支气管痉挛和血氧饱和度下降。在使用肾上腺素、β受体激动剂、吸入性抗胆碱能药物、类固醇和抗组胺药物后，建议使用氯胺酮。
需要进行试验以证明氯胺酮在这种特定情况下的疗效；然而，该病例的结果是积极的。
