Acute Myocardial Infarction Induced by Neostigmine after a Laryngoscopic Microsurgery: A Case Report

喉鏡顯微手術後發生Neostigmine誘發的急性心肌梗塞：個案報告

王亮傑(Liang-Chieh Wang) ； 馬振來(Chun-Lai Ma) ； 張錦新(Kam-Sun Cheung) ； 黃國生(Kuo-Sheng Huang) ； 陳燿舜(Yiu-Sion Chen)

《童綜合醫學雜誌》 4卷2期 (2010/12) Pp. 79-82

https://doi.org/10.29838/TMJ.201012.0005

摘要

手術期間的心肌缺血一直以來是麻醉醫師最關心的事情之一，我們報告一位進行喉鏡顯微手術之後發生急性心肌梗塞的個案。
一位65歲女性被安排做門診手術，麻醉醫師的第一次訪視是在手術當日的開刀房護理站，除了高血壓，病患本人否認任何的系統性疾患。手術時間只花了五分鐘，接下來的30分鐘病患繼續維持在麻醉狀態，以等待肌肉鬆弛劑藥效降低，病患甦醒後仍很虛弱，所以從靜脈給予neostigmine 0.5毫克與atropine 0.2毫克，很不幸的，5分鐘後氣管內管內出現了大量粉紅色泡沫狀痰，我們向病患女兒解釋病患狀況後，病患女兒才提到病患有冠狀動脈疾病病史，並且最近一週胸痛頻率有增加情形，三個小時後我們為病患做了冠狀動脈攝影，顯示左前降支有50-60%的狹窄。
發生心肌梗塞的時間與靜脈給予neostigmine的時間相當符合，neostigmine曾經報告引起冠狀動脈血管痙攣，這位病患在術前可能已有不穩定性心絞痛，由於不穩定性心絞痛是手術期間發生心血管併發症的主要危險因子，如果我們在術前即得知病患最近的病情，這個手術就應該延後，使用neostigmine在這類的病患也須特別小心。

關鍵字

心肌梗塞 ； neostigmine ； 肺水腫 ； 喉鏡顯微手術

並列摘要

Perioperative myocardial ischemia is always the anesthesiologist's major concern. We report herein a case who suffered from acute myocardial infarction after undergoing laryngoscopic microsurgery.
A 65-year-old female was scheduled as an outpatient surgery and the anesthesiologist's first visit was at the nurse station of the operation room on the operation day. All other systemic diseases were denied by the patient except hypertension. The operation only took 5 minutes, and we kept the patient anesthetized for 30 minutes to allow recovery from muscle relaxant. Neostigmine (0.5 mg) and atropine (0.2 mg) were given intravenously because patient was awaked and weak. Unfortunately, large amount of pink frothy sputum appeared in the endotracheal tube 5 minutes later. We explained the patient's condition to her daughter. Through our conversation, we noted that this patient had coronary artery disease and increased frequency of chest pain was noted in recent one week. Coronary angiography was performed 3 hours later and 50-60% stenosis of left anterior descending artery was revealed.
The time of occurring of myocardial infarction was compatible with the time of intravenous administering of neostigmine. Neostigmine had been reported to cause coronary vasospasm. This patient would have unstable angina before operation. Unstable angina is a major risk of perioperative cardiovascular complications. This procedure should have to be postponed if we had been awared of this patient's recent condition earlier. Thus, we suggest that using neostigmine in such patients should be more cautious.

並列關鍵字

myocardial infarction ； neostigmine ； pulmonary edema ； laryngoscopic microsurgery