全身麻醉後發生解離型失憶症之病例報告

Dissociative Amnesia after General Anesthesia-- A Case Report

全身麻醉後發生延遲甦醒的可能原因很多，其中極少數是肇因於精神疾病。我們在此報告一例於全身麻醉後發生解離型失憶症，造成延遲甦醒及失憶之併發症。本病例是33歲健康女性，接受alfentanil與propofol全靜脈麻醉60分鐘，直到24小時後才恢復意識，其間血液生化及神經學檢查皆正常，腦電圖及頭部電腦斷層掃瞄亦無異狀。精神科會診發現患者呈現48小時失憶症狀，於排除其他因素後確定診斷為解離型失憶症。本病例報告為文獻上首例麻醉後發生解離型失憶症，也提醒麻醉醫師面對延遲甦醒的患者時，亦須將精神疾病列入鑑別診斷。

Psychogenic unconsciousness is a rare cause of failure of prompt recovery from general anesthesia. The diagnosis is only made by exclusion of other conditions. We describe a young, healthy female who failed to wake up promptly after total intravenous anesthesia with alfentanil and propofol. She regained consciousness 24 hours later without any specific treatment. However she sustained amnesia for a period of 48 hours. Dissociative disorder was diagnosed after an extensive workup. This case report emphasizes the importance of inclusion of psychiatric disorder in the differential diagnosis should unexplainable delayed emergence from general anesthesia occur.