Mannitol外滲引起大水泡之病例報告

Bullous Eruptions Caused by Extravasation of Mannitol-- A Case Report

靜脈注射液外滲在麻醉中常會遇到，在此，我們報告一件罕見案例。病患因腦部手術麻醉中，接受mannitol靜脈注射而外滲引起手背及前臂之多處水泡病變。此乃因mannitol之高滲透壓所致。將患部舉高並以silver sulfadiazine每日敷兩次，使水泡在十天後全部消失。早期診斷及治療為成功恢復正常之關鍵，文中將描述整個過程並討論應採取之預防措施。

Extravasation is one of the common complications seen with intravenous infusion. We bring forward a case of subcutaneous mannitol extravasation, which caused swelling and multiple cutaneous bullous eruptions in the hand and forearm during craniotomy. Treatment consisting of elevation of the affected extremity and application of silver sulfadiazine ointment twice daily to the injured area was successful. The possible mechanisms relevant to extravasation and its tissue damage are reviewed and discussed. Selecting proper intravenous infusion site, using pliable catheters and frequent inspection are important steps for prevention of extravasation.