椎麻醉下牽扯闌尾誘發無預期心搏停止之病例報告

Clipping of the Appendix Induced Cardiac Arrest during Appendectomy under Spinal Anesthesia

心搏徐緩在於高位脊椎麻醉是非常常見的，但是嚴重的心搏徐緩和心搏停止是非常少見的。立即辨識可能原因，並給予急救復甦，是非常重要且可以完全恢復而不留下任何後遺症。我們報告一個病例於脊椎麻醉高度T5下，接受傳統閑尾切除手術時，因牽扯夾住盲腸而引發無預期心搏徐緩，雖立即給予atropine靜脈注射，而無法使病人回復正常心律，反而演變成心搏停止，在立即給予心臟按摩、以氧氣維持通氣並給予少量之腎上腺素而成功解救病人。相關之可能機轉及治療也在本文中討論。

Bradycardia is commonly seen in high spinal anesthesia, however, evolution of cardiac arrest from sudden onset of severe bradycardia is infrequent. Prompt recognization and resuscitative measures are of paramount importance because they may insure a complete recovery without sequela as an aftermath. We report herein a case of severe sinus bradycardia induced by clipping of the appendix during appendectomy under spinal anesthesia with the sen-sory block up to T5 dermatome. Prompt intravenous atropine failed to regain normal sinus rhythm, and cardiac arrest ensued. Cardiac massage, manual ventilation with oxygen and low-dose epinephrine successfully resuscit-ated the patient. The possible mechanisms and management of this complication are also discussed.