背景:在颈动脉内膜切除术(CEA)手术期间,血压管理对预防脑血管和心脏并发症尤为重要。麻黄碱是一种常用的血管加压药,然而,我们报道了1例患者在CEA期间静脉注射麻黄碱后出现异常严重的血压升高.
方法:一名72岁诊断为右近端颈内动脉狭窄的男性患者在全身麻醉下接受了CEA。松开颈总动脉后,服用麻黄碱(4mg)后,血压迅速升高125mmHg(从90mmHg至215mmHg),但心率稳定.
方法:在手术早期给予相同的小剂量麻黄碱后,血压顺序升高。手术方法很困难,因为他的颈动脉分叉位置很高,下颌角突出。由于颈交感神经干与颈动脉分叉的解剖接近,并且在本病例中手术过程特别复杂,我们假设这种不良反应的原因是短暂的交感神经支配超敏反应。
方法:重复给药波地平(0.5mg)以降低血压。
结果:手术后,他被诊断为右舌下神经麻痹,没有发现其他异常体征。
结论:此案例强调了使用麻黄碱的必要性,通常用于CEA手术,其中血压管理尤为重要。尽管这是一个罕见且不可预测的案例,在交感神经超敏反应可能的情况下,α-激动剂被认为更安全。
BACKGROUND: During carotid endarterectomy (CEA) surgery, blood pressure management is particularly important to prevent cerebrovascular and cardiac complications. Ephedrine is a commonly used vasopressor, however, we report the
case of a patient with unusually severe blood pressure elevation following intravenous ephedrine administration during CEA.
METHODS: A 72-year-old man diagnosed with right proximal internal carotid artery stenosis underwent CEA under general anesthesia. After declamping the common carotid artery, blood pressure rapidly increased by 125 mm Hg (from 90 to 215 mm Hg) after ephedrine (4 mg) was administered, but the heart rate was stable.
METHODS: There was an ordinal increase in blood pressure after the same small dose of ephedrine was administered at the early stage of the surgery. And the surgical approach was difficult because he had a high location of carotid bifurcation and a prominent mandibular angle. Because of the anatomical proximity of the cervical sympathetic trunk to the carotid bifurcation and the particularly complicated surgical process in the present
case, we postulate the reason for this adverse reaction as transient sympathetic denervation supersensitivity.
METHODS: Perdipine (0.5 mg) was administered repeatedly to reduce blood pressure.
RESULTS: After surgery, he was diagnosed with right hypoglossal nerve palsy, and no other abnormal signs were found.
CONCLUSIONS: This
case highlights the need for caution in the use of ephedrine, which is commonly used in CEA surgery, wherein blood pressure management is particularly important. Although it is a rare and unpredictable
case, α-agonists are considered safer in situations where sympathetic supersensitivity is possible.