對接受疝氣修補術之病人施行高位脊椎麻醉而掩蓋心肌梗塞症狀表現之病例報告

Myocardial Infarction Masked by High Level Spinal Anesthesia in a Patient Undergoing Herniorrhaphy

術中或術後的心肌梗塞往往是造成圍手術期併發症的主因。儘管直至目前為止，仍然沒有確切證據證明相較於全身麻醉，區域麻醉較可降低術中或術後心肌梗塞的發生率，但是對於有可能發生術中心肌梗塞的病患接受下肢或下腹手術時，多數的麻醉醫師會選擇區域麻醉。但高位的區域麻醉卻有可能使病人在發生心肌梗塞時感覺不出反射痛而延誤診治。我們報告一 位發生心肌梗塞的病患，其反射痛的症狀可能被高位的脊椎麻醉所掩蓋，直至麻醉消退後方被診斷，從而假設高位的脊椎麻醉有可能使心肌梗塞的反射痛變的較不明顯。

Myocardial infarction (MI) is one of the leading causes of perioperative morbidity. Although evidence to prove significant reduction of perioperative MI with regional anesthesia is lacking, anesthesiologists still prefer this technique over general anesthesia for surgery involving the lower abdomen or lower extremities, especially in patients with cardiac risks. However, high level of sensory block during spinal anesthesia may obscure the referred pain from MI, which could contribute to the delay of diagnosis and treatment of an acute perioperative attack. We report a case of MI which occurred either intraoperatively or postoperatively, with symptoms that were masked by high level of sensory block to T4 by spinal anesthesia. This perioperative MI was only diagnosed when the patient recovered from anesthesia in the post-anesthesia care unit (PACU).