以Physostigmine恢復手術後之延長嗜睡－病例報告

Reversal of Postoperative Somnolence with Physostigmine

戴元基(Y. J. Day) ； 何善台(Shung-Tai Ho) ； 胡幼圃(Oliver Y. P. Hu) ； 王昀(Y. Wang) ； 胡新實(Jenkin S. Hu) ； 郭文雄(Wein-Shung Kuo)

《Journal of Medical Sciences》 10卷2期 (1989/04) Pp. 113-116

摘要

病人為五十二歲男性，體重五十五公斤，手術前懷疑是Maxillary cyst，上午九點進入開刀房準備接受Caldwell-Lac operation，九點三十分開始麻醉誘導，所使用藥物為d-Tubocurarine 3mg i.v.，Thiopental 250 mg i.v.，再以Succinylcholine 80 mg i.v.以利插入氣管內管，使用Enflurane 0.5-1.5 %，N2O：O2 = 2L：2L，Fentanyl 0.2 mg i.v.及Pancuronium 4 mg i.v.手術時間共三小時，術後病人呼吸良好，唯意識不清，對外界刺激無反應，送至麻醉恢復室（PAR）中觀察，在PAR三小時仍無任何進展，其間分別做了兩次動脈氣體分析數據正常；施行神經檢查無特殊發現，兩側瞳孔大小及光反射正常；病人對疼痛刺激稍有反應；以神經刺激器刺激顯示肌肉力量已恢復，應無肌肉鬆弛劑之影響，經給予Naloxone 0.4 mg，病人並無任何改善。三十分鐘後則給予Physostigmine 0.6 mg，0.6 mg，0.8 mg i.v.其間隔3－5分鐘，病人於給完Physostigmine 2.0mg三十秒後完全甦醒，對於疼痛有反應，並能回答問題。因此我們認為：使用Physostigmine可以恢復手術後之延長嗜睡。

關鍵字

術後嗜睡

並列摘要

Physostigmine penestrates the blood brain barrier easily and increases acetycholine levels by inhibiting cholinesterase. It has been used clinically to reverse central nervous system depression induced by a variety of agents for its anticholinergic properties. This was a 52 year-old male patient with maxillary cyst who underwent removal of cyst under general anesthesia. Preoperative examinations showed the results within normal limits in aspects of physical examination, ECG, chest x-rayed examination and biochemistry with exception of cystic lesion over left maxillary area. Anesthesia was induced with d-tubocurarine 3mg i.v., thiopental 250 mg i.v, and trachea was intubated with aid of succinylcholine 80 mg i.v.. Anesthesia was maintained with nitrous oxygen in oxygen (50%), enflurane 0.5-1.5%, fentanyl 0.2 mg i.v, and pancuronium 4 mg i.v.. During anesthesia, stable blood pressure, body temperature around 36.5 C, and arterial blood gas analysis (ABG) and electrolytes within normal limits were noted. After surgery, though the patient was no response to simple command and noxious stimulation, neostigmine 2 mg i.v. and atropine 1.0 gm i.v. were given to reverse residual neuromuscular blockade in order to remove endotracheal tube. Three and half an hours after surgery, patient was slight response to noxious stimulation and therefore naloxone 0.4 mg was administered to try to improve conscious status but in vain. Thirty minutes later, we gave physostigmine 0.6 mg, 0.6 mg and 0.8 mg i.v. at intervals of 3.5 min. Immediately after injection of physostigmine 2.0 mg, patient's consciousness became clear with comprehensive and communicable speech dramativally. During observing the patient, we withdrew blood to measure thyroid function, cortisol level and thiopental concentration, and the results of the first two tests were within normal range and thiopental concentration was 0.65 ng/min (in elimination phase). Through a careful review of an anesthetic record and laboratory data, there was no sole drug which could induce prolonged post-operative somnolence and thus the somnolence could be caused by multiple factors. However, we suggest to try phsostigmine to reverse postoperative somnolence.

並列關鍵字

Physostigmine ； Postoperative somnolence