鼻內手術之局部麻醉併發癲癇

鼻中隔鼻道成形術及下鼻甲切除術是耳鼻喉科常做的鼻內手術，其術後併發症並不常見，而術中之併發症亦罕有文獻發表。本科最近經歷二例接受鼻內手術（鼻中隔鼻道成形術及下鼻甲切除術）之病人，於術中注射完局部麻藥之後病人突然併發癲癇的症狀，故緊急改上全身麻醉進行手術。經探討此急速產生抽搐之原因可能是由於藥物經靜脈或動脈回流至腦部循環中所造成，故在鼻部手術施打局部麻醉時須特別注意回抽注射器確定無回血，避免將麻醉藥物注入血管中，以免發生類似的併發症：另者，需有完善之病人監視系統，如血氧濃度、心電圖、血壓等，以隨時注意病人狀況以免意外發生。

關鍵字

癲癇；局部麻醉；鼻中隔鼻道成形術

並列摘要

Septomeatoplasty and inferior turbinectomy are the most common surgical procedures in otolaryngology. The post-operative complications are unusual, and there have been no report of complications due to local anesthesia administered during septomeatoplasty and inferior turbinectomy. Recently, we experienced two cases who received septomeatoplasty and inferior turbinectomy of seizure attacks soon after the injection of small doses of local anesthetic to the nasal mucosa. We consider that cause of the seizure immediately following the injection of local anesthetic in the inferior turbinate is probably due to infiltration into venous or arterial systems with retrograde flow to the brain circulation. In nasal surgery, during local anesthetic injection, the operator must reexamine whether blood ran into the syringe using needle aspiration to prevent intravascular injection. Meanwhile, appropriate monitoring systems of patients including a standard electrocardiogram, frequent blood pressure determinations and pulse oximeter are necessary.

並列關鍵字

seizure ； local anesthesia ； septomeatoplasty

國際替代計量

鼻內手術之局部麻醉併發癲癇

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