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首页> 外文期刊>麻酔 >Accidental use of suxamethonium for general anesthesia in a patient with hereditary hypocholinesterasemia that was not recognized preoperatively
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Accidental use of suxamethonium for general anesthesia in a patient with hereditary hypocholinesterasemia that was not recognized preoperatively

机译：意外使用Suxamethium在患有遗传性脱胆碱血症的患者中的全身麻醉，术前没有识别

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We experienced an accidental use of suxamethonium for general anesthesia in a 26-year-old woman with hereditary hypocholinesterasemia that had not been recognized preoperatively. The patient was scheduled for total colectomy as her chronic ulcerative colitis could not be controlled with medications. Routine preoperative screening such as blood cell counts, biochemical data, chest x-ray and electrocardiogram were performed but serum cholinesterase (ChE) activity was not measured. As the preoperative patient condition was good with no abnormal history, anesthesia was induced and maintained with propofol, ketamine and fentanyl as usual. For muscle relaxation, suxamethonium was used for tracheal intubation, and vecuronium was used for the maintenance. After surgery, postanesthetic course was uneventful. One year later, as the patient was pregnant and scheduled for cesarean section, the preoperative screening was done. The biological data showed a hypocholinesterasemia without liver dysfunction. Thus, previous medical records of internal medicine were cheked. Surprisingly the record showed hypocholinesterasemia when she was 15 and 21 years of ages. However, as the physicians did not recognize hypocholinesterasemia, they did not inform the patient of it. Why did the patient have no prolonged apnea and emergence after the previous anesthesia? As the surgical time was exceeded 4 hrs, plasma suxamethonium could fortunately be less than its effective concentration at emergence. However, this case strongly suggests us that preoperative screening should be done without any omission. In addition, if serum ChE activity is not examined, use of suxamethonium should be avoided.
机译：我们经历了全身麻醉的意外使用琥珀胆碱的26岁女子与遗传性hypocholinesterasemia尚未被认可的术前。病人被安排在全结肠切除她的慢性溃疡性结肠炎无法药物控制。进行术前常规筛选如血细胞计数，生化数据，胸部X射线和心电图，但没有测量血清胆碱酯酶（CHE）的活性。由于术前患者状况良好无异常史，麻醉诱导和丙泊酚，氯胺酮和芬太尼像往常一样保持不变。对于肌肉松弛，用于气管插管琥珀胆碱，并用于维护维库溴铵。手术后，麻醉后当然很顺利。一年后，当患者怀孕并计划于剖宫产，术前筛选完成。生物数据显示，无肝功能障碍的hypocholinesterasemia。因此，内科以往病历cheked。令人惊讶的是记录显示hypocholinesterasemia当她是15至21岁年龄段的。然而，由于医生不承认hypocholinesterasemia，他们并没有通知它的病人。为什么病人有以前麻醉后无呼吸暂停时间延长，并出现？由于手术时间被超过4个小时，血浆琥珀胆碱能好在比在出苗其有效浓度以下。然而，这种情况下，强烈地暗示我们，术前检查应没有任何遗漏地进行。此外，如果没有检查血清胆碱酯酶活性，应避免使用琥珀胆碱。

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