【罂粟摘要】术中酒精阻滞腹腔神经丛后出现躁动：一项病例汇报
术中酒精阻滞腹腔神经丛后出现躁动：一项病例汇报
贵州医科大学 高鸿教授课题组
翻译：张中伟 修改/编辑：佟睿 审校：曹莹
全麻后出现的躁动在临床上可能会使病人在麻醉恢复期间产生一些不良事件，而急性酒精中毒虽然在手术中很少见，但却是危险因素之一。
一名66岁男性患者经CT检查发现患有胰尾肿瘤。外科医生计划在全身麻醉下切除胰尾。然而，外科医生发现腹腔内有广泛的肿瘤转移，因此用40毫升95%乙醇进行腹腔神经丛阻滞（NCPB），并在大约1小时内完成手术。20分钟后，患者拔除气管导管，并在麻醉恢复室出现明显的躁动，其特征为精神不安、运动无法控制、困惑和定向障碍。病人脸红发热，呼气中带有酒精味，无法按指令行动。我们怀疑病人的症状是由于急性酒精中毒引起的。因此，为患者静脉注射40毫克丙泊酚。经治疗后，患者在大约10分钟后恢复，嗜睡程度和定向障碍情况转好。在两次以上丙泊酚治疗后，患者意识恢复，躁动消失，可与医务人员合作，无疼痛现象，在最后一次治疗大约1小时40分钟后可以按指令行动。治疗后，患者被转移到住院病房，感觉良好。
由于不同病因患者的治疗方案不同，因此正确识别出现躁动的根本原因对于成功解决患者出现的症状至关重要。出现躁动可能是由于术中使用酒精后急性酒精中毒所致。
Huixuan Zhou, Yinbing Pan, Cunming Liu , et al. Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report.[J]. BMC Anesthesiol(2021) 21:204:1.
Emergence agitation after intraoperative neurolytic celiac plexus block with alcohol: a case report
Abstract
Background: Emergence agitation after general anesthesia may cause several undesirable events in the clinic during patient anesthesia recovery, and acute alcohol intoxication, while rare in surgery, is one of the risk factors.
Case presentation: A 66-year-old male patient was found to have pancreatic tail neoplasm upon computed tomog-raphy (CT) examination. The surgeon planned to resect the pancreatic tail under general anesthesia. However, the
surgeon found extensive tumor metastasis in the abdominal cavity, and thus performed a neurolytic celiac plexus block (NCPB) with 40 ml 95% ethyl alcohol and finished the surgery in approximately 1 h. Twenty minutes later, the patient was extubated and developed significant emergence agitation in the postoperative care unit, characterized by restlessness, uncontrollable movements, confusion and disorientation. The patient was flushed and febrile with an alcohol smell in his breath and was unable to follow commands. Patient symptoms were suspected to be due to acute alcohol intoxication. Thus, the patient was given 40 mg of propofol intravenously. Following treatment, the patient recovered with less confusion and disorientation after approximately 10 min. After treatment with propofol twice more, he regained consciousness, was calm and cooperative, had no pain, and could obey instructions approxi-mately 1 h and 40 min following the last treatment. Following this treatment, the patient was transferred to the inpatient ward and felt well.
Conclusion:It is paramount to correctly identify the underlying cause of emergence agitation in order to success-fully manage patient symptoms, since treatment plans vary between different etiological causes. Emergence agitation may be due to acute alcohol intoxication after intraoperative use of alcohol.
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