靜脈給予Propofol加重意外注射Thiopental到硬脊膜外腔引起之低血壓

Intravenous Propofol Precipitates the Hypotension Induced by Inadvertent Epidural Thiopental Injection

加入不正確的藥物到硬脊膜外腔在麻醉中偶而會發生，大部分不會引起嚴重的神經學併發症。未曾有報告因意外加入thiopental到硬脊膜外腔而引起嚴重低血壓的徵候。我們報告一例意外注射thiopental到硬脊膜外腔，同時以propofol進行麻醉誘導引起的嚴重低血壓，需要積極的以強心劑及升壓劑治療。Thiopental在硬脊膜外腔中被血管快速吸收與propofol的協同作用而引起嚴重低血壓。除非有明顯的症狀或神經受損的徵候，採取積極的治療是不必要的。

Administration of improper drugs into epidural space is occasionally present in anesthetic practice. In most instances it would not contribute to significant neurological complications. There had not been severe hypotension reported in the literature in consequence of inadvertent epidural thiopental administration. Here we describe our experience in a case of inadvertent epidural administration of thiopental coinciding with induction of anesthesia with propofol, as a consequence of which profound hypotension was induced, necessitating aggressive inotropic and vasopressive agents to maintain blood pressure. Rapid vascular uptake of thiopental in the epidural space and synergistic action of propofol jointly contributed to the development of the hypotension. Attempts to forestall neurological sequela after the inadvertence seem unnecessary unless apparent symptoms or signs of neurological injury have come upon.