Shimada J, Akama Y, Tase C, Okuaki A
Department of Anesthesiology, Fukushima Medical College.
Masui. 1994 Aug;43(8):1248-50.
We describe three cases of extrapyramidal reactions apparently caused by epidural administration of droperidol. These patients suffered from chronic pain and was treated with epidural lidocaine and droperidol. Two patients received continuous administration of droperidol, and experienced acute dystonia and another after a single dose, developed akathisia. Adverse reactions occurred at 15, 20 and 24 hours after the administration of droperidol. The first patient received droperidol 6 mg, the second 8.5 mg and the third 5 mg. We consider that extrapyramidal reactions are due to overdoses because the patients who had been given less than 2.5 mg of droperidol a day, showed no adverse reaction. Although we use higher doses with NLA or for management of fever than with epidural administration of droperidol, we seldom encounter cases of side effects with droperidol. Epidurally administrated droperidol spreads rostral within the neuraxis and causes delayed extrapyramidal reactions as epidural morphine develops delayed respiratory depression. We must be careful in caring patients suffering from chronic pain with continuous epidural administration of droperidol.
我们描述了三例锥体外系反应,显然是由硬膜外注射氟哌利多引起的。这些患者患有慢性疼痛,接受了硬膜外利多卡因和氟哌利多治疗。两名患者接受了氟哌利多持续给药,出现急性肌张力障碍,另一名患者单次给药后出现静坐不能。不良反应发生在氟哌利多给药后15、20和24小时。第一名患者接受了6毫克氟哌利多,第二名患者接受了8.5毫克,第三名患者接受了5毫克。我们认为锥体外系反应是由于用药过量,因为每天服用氟哌利多少于2.5毫克的患者未出现不良反应。虽然我们在神经阻滞麻醉(NLA)或治疗发热时使用的氟哌利多剂量高于硬膜外给药,但我们很少遇到氟哌利多的副作用病例。硬膜外注射的氟哌利多在神经轴内向上扩散,并像硬膜外吗啡导致延迟性呼吸抑制一样,引起延迟性锥体外系反应。在持续硬膜外注射氟哌利多治疗慢性疼痛患者时,我们必须谨慎护理。