背景:围手术期高乳酸血症的原因各不相同,但它们通常与灌注不足有关。这里,我们报道了一例儿科患者在丙泊酚和七氟烷麻醉期间出现了原因不明的高乳酸血症,在用雷米唑仑麻醉的第二次手术中复发。
方法:一名8岁男孩患有Perthes病,没有明显的既往史或家族史,计划进行截骨手术。用丙泊酚和罗库溴铵诱导麻醉,然后用七氟醚和瑞芬太尼维持麻醉。患者在麻醉期间出现乳酸性酸中毒,无血流动力学不稳定,手术后乳酸/丙酮酸比率正常,提示缺乏灌注不足。在6个月后的第二次手术中,我们使用了雷米唑仑代替异丙酚,考虑到药物引起的乳酸性酸中毒的可能性,包括恶性高热和丙泊酚输注综合征,原因不明的高乳酸血症复发.
结论:区分高乳酸血症的原因,特别是在没有其他症状的情况下,具有挑战性。高乳酸血症发作期间的乳酸/丙酮酸比率可以提供对潜在病理的见解。
BACKGROUND: The causes of perioperative hyperlactatemia vary, but they are generally associated with hypoperfusion. Here, we report the case of a pediatric patient who developed unexplained hyperlactatemia during anesthesia with propofol and sevoflurane, which recurred during a second surgery under anesthesia with remimazolam.
METHODS: An 8-year-old boy with Perthes disease and no remarkable past or family history was scheduled for an osteotomy. Anesthesia was induced with propofol and rocuronium and then maintained with sevoflurane and remifentanil. The patient developed lactic acidosis without hemodynamic instability during anesthesia, with a normal lactate/pyruvate ratio after surgery, suggesting a lack of hypoperfusion. We used remimazolam instead of propofol during the second surgery 6 months later, considering the possibility of drug-induced lactic acidosis, including malignant hyperthermia and propofol infusion syndrome, where the unexplained hyperlactatemia recurred.
CONCLUSIONS: Distinguishing the causes of hyperlactatemia, particularly in the absence of other symptoms, is challenging. The lactate/pyruvate ratio during episodes of hyperlactatemia can provide insights into the underlying pathology.