Currier D S, Bevacqua B K
Department of Anesthesiology, Case Western Reserve University, Cleveland, OH, USA.
J Clin Anesth. 1997 Aug;9(5):420-3. doi: 10.1016/s0952-8180(97)00019-6.
We treated a patient with a 30-year history of ethanol and benzodiazepine abuse who, on emerging from general anesthesia, was combative and confused. Our working diagnosis was acute ethanol withdrawal, and the patient received intravenous (i.v.) propofol, and midazolam. Initially small doses (10 to 20 mg) of propofol, combined with a midazolam infusion (50 mg/hr), produced sedation. Later, however, the patient became increasingly combative, confused, hypertensive, and tachycardic despite an i.v. propofol infusion at doses up to 1,000 micrograms/kg/min (total propofol dose: 1,755 mg). Immediate sedation was produced by thiopental bolus (500 mg) and i.v. infusion (200 mg/hr). The implication of the patient's initial appropriate response to propofol, followed by the lack of effect when much higher doses were employed, is discussed. While tachyphylaxis has been reported after long-term propofol use, we believe this to be the first case of acute tachyphylaxis.
我们治疗了一位有30年乙醇和苯二氮䓬滥用史的患者，该患者在全身麻醉苏醒后出现躁动和意识模糊。我们初步诊断为急性乙醇戒断，给予患者静脉注射丙泊酚和咪达唑仑。最初，小剂量（10至20毫克）的丙泊酚联合咪达唑仑输注（50毫克/小时）可产生镇静效果。然而，后来尽管静脉输注丙泊酚的剂量高达1000微克/千克/分钟（丙泊酚总剂量：1755毫克），患者仍变得越来越躁动、意识模糊、高血压和心动过速。硫喷妥钠推注（500毫克）和静脉输注（200毫克/小时）立即产生了镇静作用。本文讨论了该患者最初对丙泊酚有适当反应，而使用更高剂量时却无效的情况。虽然长期使用丙泊酚后曾有快速耐受的报道，但我们认为这是急性快速耐受的首例病例。
