疑似對局部麻醉劑過敏病史之處置及病例報告

局部麻醉劑對於每日的牙科工作是不可或缺的。本文提出民國九十五年間，國泰醫院牙科所發生的兩例疑似對局部麻醉劑過敏之病史及其處理。患者皆於手術前裝置靜脈導管，給予減敏療程，並於術中監測血壓及EKG，在局部注射牙科用mepivacaine下，手術過程順利，患者於術中及術後並無任何不適。當患者有疑似局部麻醉劑過敏之病史時，若已知患者過敏的藥劑爲何，則可改用其他種類之局部麻醉劑做替代，並在注射前先行皮膚測試以確保患者安全。若是與法得知過敏藥劑爲何，可將病人轉介至過敏風濕免疫專科醫師測試過敏原。另外若僅爲簡單口腔手術，且所需時間少於30分鐘，則可改用diphenhydramine (DPH)作爲替代之局部麻醉劑，惟仍需臨床實證。但若是患者需要之口腔手術較複雜，且手術時間可能超過半小時，則可參考本文提出之減敏療程，再使用傳統局部麻醉劑，以達成手術所需之麻醉深度。

關鍵字

局部麻醉劑；過敏反應

並列摘要

Local anesthesia is the dental daily work. Allergic reaction seldom occurs. But if the patient comes with the history of allergy-like reaction to local anesthetics, we will hesitate to do it. This article presents two cases with allergy-like history to local anesthetics, and deals with the treatment protocol. These two patients were hospitalized for teeth removal. The desensitization course was given, then local anesthesia with mepivacaine injection was done.. Ⅳ lines and EKG monitor were set up during the surgery. It went smoothly through the whole procedure.The local anesthetics are divided into two groups-ester type and amide type. If the patient comes with the known allergic anesthetics, we can change it into another type. For safety reason, we need to perform skin test before injection. If the patient comes with unknown allergic anesthetics, we can use diphenhydramine (DPH) as the anesthetic substitute for short duration within 30 minutes. However, if profound anesthesia is needed, the regimen of hospitalization, vital sign monitoring, and the desensitization course plus local anesthesia is a good choice.

並列關鍵字

local anesthetic agents ； hypersensitivity

國際替代計量

疑似對局部麻醉劑過敏病史之處置及病例報告

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