当瞳孔撒谎时:在整形外科手术期间揭露未被注意到的高脊柱麻醉
Kartik Sonawane1, Sumeet Patil1, Satheesh Kumar1
1Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd., Coimbatore, IND.
Cureus
|October 10, 2025
概括
高脊髓麻醉,神经轴技术的罕见并发症,可以潜伏地呈现神经症状. 这一案例凸显了其可逆性质以及小心对导管管道的管理的重要性.
科学领域:
- 麻醉学 麻醉学
- 神经学 神经学
- 手术并发症 手术并发症
背景情况:
- 高脊椎麻醉是一种神经轴麻醉的罕见并发症.
- 它可以潜伏地呈现神经症状,与全脊髓麻醉的剧烈心血管崩不同.
研究的目的:
- 报告一个高脊柱麻醉病例后,结合脊柱-外皮麻醉 (CSEA).
- 强调识别和管理这种并发症的重要性.
主要方法:
- 一个23岁的多创伤患者的病例报告,接受了股骨和骨固定.
- 进行了联合脊髓-外周麻醉 (CSEA).
- 脑神经系统的恶化发生在外围注射后,揭示了脑内导管迁移.
主要成果:
- 患者突然失去了反应,瞳孔固定,扩张,但血液动力学和通风保持稳定.
- 手术后的评估证实了内外导管迁移,扩展了T2以上的阻塞.
- 患者在30分钟内恢复了意识,没有进行呼吸道干预,显示过渡性低通风.
结论:
- 不被注意到的高脊髓麻醉可以模仿严重的神经或栓塞事件,但往往是可逆的.
- 细致的外周导管管理和结构化的差异诊断至关重要.
- 对潜在的气道干预做好准备是必不可少的.
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