Grell Ryan
Anesthesiology, University of Louisville School of Medicine, Louisville, Kentucky, USA
BMJ Case Rep. 2023 Feb 21;16(2):e253592. doi: 10.1136/bcr-2022-253592.
A patient in his 20s with a history of granulomatosis with polyangiitis required 15 bronchoscopies with dilations in 1 year due to bronchial fibrosis and secretions leading to worsening shortness of breath. During these bronchoscopies, the patient experienced increasingly severe bronchospasms refractory to conventional preventative and treatment methodologies leading to prolonged hypoxia, reintubations and ICU admissions. During his 8th to 15th bronchoscopies, nebulised lidocaine was added to the pretreatment regimen, which eliminated perioperative bronchospasms and allowed for the elimination of all other adjunctive preventative treatments. This case highlights the novel perioperative use of nebulised lidocaine, in combination with nebulised albuterol and intravenous hydrocortisone, to successfully prevent previously refractory bronchospasms in a patient undergoing a general anaesthetic.
一名20多岁患有肉芽肿性多血管炎的患者，由于支气管纤维化和分泌物导致呼吸急促加重，在1年内需要进行15次支气管镜扩张术。在这些支气管镜检查过程中，患者经历了越来越严重的支气管痉挛，常规预防和治疗方法对此无效，导致长时间缺氧、再次插管和入住重症监护病房。在他第8次至15次支气管镜检查期间，雾化利多卡因被添加到预处理方案中，这消除了围手术期支气管痉挛，并使得所有其他辅助预防治疗得以取消。该病例突出了雾化利多卡因与雾化沙丁胺醇和静脉注射氢化可的松联合在围手术期的新用途，以成功预防一名接受全身麻醉患者先前难以治疗的支气管痉挛。
