Acute Pulmonary Edema Associated with Intravenous Ketamine during Cesarean Section

緊急剖腹生產中因靜脈注射Ketamine引發急性肺水腫

梁深維(Sum-Wai Leung) ； 陳重榮(Trong-Zong Chen)

《北市醫學雜誌》 9卷3期 (2012/09) Pp. 251-262

https://doi.org/10.6200/TCMJ.2012.9.3.07

摘要

目的：報告一個在緊急剖腹生產過程中使用ketamine後發生急性肺水腫的案例。病例報告：一位35歲65公斤38週無特殊疾病的孕婦，因臀位和早期破水接受緊急剖腹生產。手術中給予靜脈注射75毫克ketamine以抑制疼痛反應。約10分鐘後，病患出現呼吸困難。當時沒有呼吸道阻塞情形。氣管插管後，可見粉紅色泡沫狀痰液從氣管內管冒出。該病患於加護病房接受T型管呼吸治療，隔日即移除氣管內管。導致肺水腫的可能機制包括ketamine引發肺血管性高血壓、抑制心肌或抑制肺液清除功能。結論：在剖腹生產中，給予孕婦靜脈注射ketamine可能導致急性肺水腫。

關鍵字

ketamine ； 肺水腫 ； 剖腹生產

並列摘要

Objectives: We report a case of acute pulmonary edema following intravenous ketamine administration during cesarean section. Case Report: A 35 years old 65kg woman pregnant at the 38th week presented with a breech presentation and premature rupture of the membrane. An emergency cesarean section was performed under spinal anesthesia using 10mg of bupivacaine. During the operation, 75mg of ketamine was given intravenously as an adjunct to enhance pain suppression. About 10 minutes later, respiratory distress occurred. There was no evidence of airway obstruction. After intubation, pink frothy sputum emerged from the endotracheal tube. She was managed with T-piece breathing in the intensive care unit and was extubated on the next day. The mechanism causing the pulmonary edema may have involve ketamine related pulmonary vascular hypertension, myocardial depression or lung fluid clearance inhibition. Conclusions: Intravenous ketamine may induce acute pulmonary edema in a pregnant woman during cesarean section.

並列關鍵字

ketamine ； pulmonary edema ； cesarean section