腰麻-硬膜外间隙联合阻滞(combine spinal-epidural block,CSE)是椎管内麻醉的一种,广泛用于下腹部及下肢手术。
具有腰麻起效快、镇痛完善与肌肉松弛的优点,也具有硬膜外阻滞时调控麻醉平面、满足长时间手术的需要的长处。
但另一方面,也可能带来腰麻和硬膜外阻滞双重的麻醉风险。
主要有一下几个:
腰麻后头痛
尿潴留
腰麻后神经并发症:脑神经麻痹出现头痛、眩晕、斜视和复视;粘连性蛛网膜炎;马尾丛综合征。
化脓性脑脊膜炎;
全脊麻;
局麻药中毒反应;
血压下降;
呼吸抑制
恶心呕吐;
神经损伤;
硬膜外血肿;
脊髓前动脉综合征;
硬膜外脓肿;
导管拔出困难或折断。
但,腰硬联合麻醉引起声带麻痹??这应该是全身麻醉气管插管的一种并发症吧?你确实没看错,腰硬联合麻醉后一例患者出现声带麻痹,并且合并马尾综合征。
下面来详细看一下这个罕见的病例。
你们觉得发生声带麻痹的原因是什么?欢迎留言!
腰硬联合麻醉后声带麻痹及马尾综合征1例
根本原因
声带麻痹和马尾综合征是非常罕见的神经功能损伤。本报告描述了一例病例在顺利施行0.5%重比重布比卡因腰硬膜外麻醉后同时出现声带麻痹和马尾综合症。
病例详情
该病例为45岁女性,因双侧踇外翻而接受手术,在顺利施行腰硬联合麻醉后出现马尾综合征和单侧声带麻痹。在穿刺针穿刺或药物注射期间没有疼痛或感觉异常。手术进行得很顺利。
诊断
软性喉镜检查确诊右侧声带麻痹。
干预
在顺利施行腰硬联合麻醉后,患者开始接受双侧踇外翻的手术治疗,术后出现马尾综合征和单侧声带麻痹。
结果
临床表现为:术后排尿困难。
出现单侧声带麻痹,其特征是:
声音嘶哑;
发声困难;
并被液体呛到。
腰骶部进行磁共振成像(MRI):完全正常。
颈部、胸部和头骨进行计算机断层扫描(CT):完全正常。
软性喉镜检查显示:右侧声带麻痹。
虽然马尾综合征的发生可能是由于局部麻醉药的神经毒性,但声带麻痹的确切病因尚不确定的。
经验教训
该病例强调了两个腰硬联合麻醉罕见的和严重的并发症甚至可以发生在同一个病人身上,即使手术和麻醉都顺利实施。
原文摘要
Vocal fold paralysis and cauda equinasyndrome following spinal-epidural anesthesia: A case report
Rationale
Vocalfold paralysis and cauda equina syndrome are very rare neurologic deficits.This report describes the case of a patient who simultaneously developed bothafter uneventful spinal-epidural anesthesia with 0.5% hyperbaric bupivacaine.
Patient concerns
Wereport the case of a 45-year-old female, who underwent surgery for bilateralhallux valgus developed cauda equina syndrome and unilateral vocal foldparalysis after uneventful spinal-epidural anesthesia was administered. Therewas no pain or paresthesia during needle placement or drug injection. Surgerywas performed uneventfully.
Diagnoses
Rightvocal fold paralysis was diagnosed with flexible laryngoscopy.
Interventions
Patientwas started on the treatment with a surgery for bilateral hallux valgus, whodeveloped cauda equina syndrome and unilateral vocal fold paralysis afteruneventful spinal-epidural anesthesia was administered.
Outcomes
Postoperatively,she had difficulty in urination and defecation. In addition, she developedunilateral vocal fold paralysis characterized by hoarseness, effortful voiceproduction, and choking with liquids. Magnetic resonance imaging performed onthe lumbosacral area and computed tomography of the neck, the chest, and theskull revealed entirely normal results. However, flexible laryngoscopy revealeda right vocal fold paralysis. Although cauda equina syndrome can occur due toneurotoxicity of local anesthetics, the exact etiology of vocal fold paralysisis uncertain.
Lessons
Thecase highlights that 2 rare and serious complications of spinal-epiduralanesthesia can even occur in the same patient after uneventful surgery andblock performance.
原文链接:
XiangY, Wang W, Jing S, Zhang Z, Wang D. Vocal fold paralysis and cauda equinasyndrome following spinal-epidural anesthesia: A case report. Medicine(Baltimore). 2021 Jan 22; 100(3): e24374. doi: 10.1097 / MD. 0000000000024374. PMID:33546075; PMCID: PMC7837849.
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