#36044眼科阻滞后围手术期超敏反应一例报告

Anderson Gonçalves, Paulo Sérgio M M Serzedo, Flávio Coelho Barroso
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摘要

背景和目的围手术期超敏反应(PHR)是麻醉医师每天非常关注的问题。在手术过程中,在任何麻醉中顺序使用几种药物,这可能引发或轻或重的过敏反应。否则,过敏反应是一种严重的、危及生命的全身性过敏反应,在接触致敏剂后迅速发生。结果病例报告:56岁女性,ASA P1,无任何已知过敏,接受右眼小梁切除术。给予咪达唑仑和芬太尼镇静,在充分无菌条件下对眼球进行球周阻滞,注射1%罗哌卡因5 ml,透明质酸酶300 UI,尼科尔评分,等于8分,四象限肌动障碍。3小时后,患者眼眶周围组织出现轻度水肿,病情自行消退。5天后,由于手术失败,患者返回诊所进行相同的手术。阻断几分钟后,患者出现重要的眶周冷水肿,伴有恶心和荨麻疹,诊断假设为Ring &提出了梅斯默量表。立即给予肾上腺素20微克、氢化可的松250毫克等量治疗和临床支持,导致症状消退。关于围手术期超敏反应的命名近来有了新的共识,因为一些术语已不再使用。除此之外,症状的可变性对麻醉医生在护理患者时提出了挑战,他们可以诊断和治疗任何可疑的围手术期过敏反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
#36044 Perioperative hypersensitivity reaction after an ophtalmologic block: case report

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims

Perioperative hypersensitivity reactions (PHR) are of great concern to anesthesiologists daily. During a procedure, several agents are administered sequentially in any anesthesia, which can trigger allergic reactions of lesser or greater severity. Otherwise, anaphylaxis is a severe, life-threatening, systemic allergic reaction that occurs rapidly after exposure to a sensitizing agent.

Results

Case report: 56 years-old female, ASA P1, without any known allergies, was admitted to right eye trabeculectomy. Sedation was performed with midazolam and fentanyl to perform the peribulbar block of the eye under adequate asepsis, with injection of 5 ml of 1% ropivacaine and 300 UI of hyaluronidase, with Nicoll Scale, equal to 8, four-quadrant akinesia. After 3 hours, the patient presented slight edema in periorbital tissue, with spontaneous regression of the condition. After 5 days, the patient returned to the clinic to perform the same surgery the eye due procedure failure. After a few minutes from the blockade, the patient presented an important periorbital cold edema, associated with nauseas and urticaria, and the diagnostic hypothesis of PHR class II of Ring & Messmer Scale was suggested. The treatment was immediately performed with aliquots of 20mcg of adrenaline, 250 mg of hydrocortisone and clinical support, that led to regression of the symptoms.

Conclusions

Discussion

Recently, a new consensus was released about the nomenclature of perioperative hypersensitivity, since some terms are not used anymore. Besides that, the variability of symptoms challenges the anesthesiologist in care of the patient, that can be able to diagnose and treat any suspected perioperative allergic reactions.
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