Analysis of 2 cases of pediatric tide red caused by static injection of hydrochloric acid ethyle ethyl ether before anesthesia

The use of anticholinergic drugs before anesthesia can reduce the complications of anesthesia and surgery, and reduce the risk of perioperative surgeryEspecially for children, before surgery to give a sufficient amount of anticholinergic drugs, can effectively reduce the oral pharynx and respiratory secretions,preventtrachea intubation operation and surgery during the pull may cause the vagus nerve reflexThe use of anticholinergic drugs before anesthesia can reduce the complications of anesthesia and surgery, and reduce the risk of perioperative surgeryEspecially for children, before surgery to give a sufficient amount of anticholinergic drugs, can effectively reduce the oral pharynx and respiratory secretions,preventtrachea intubation operation and surgery during the pull may cause the vagus nerve reflexHowever, there are few reports of side effects caused by the use of ethyl ethyl hydrochloride in pediatrics before pediatric surgery, this paper combines the following 2 cases to analyze the possible causes and treatment of pediatric seisch caused by the aestherheumite acetate in the following 2 cases:1.
Clinicaldatacases 1, female, 8 years old, weight 19kg, height 120 cm, the main cause of "spastic cerebral palsy, double horseshoe foot deformity" admitted to the hospital, intended in the whole hemp children cerebral palsy double lower limb muscle loose surgery, gypsum fixationThere were no abnormalities in the indicators of preoperative examination of the patient2016-6-78:00 Patients enter the operating room, connected to electrocardiogram, BP105/65mmHg, HR95 times/min, SpO2 99%Open peripheral veins, conventional rehydration, intravenous pot to give hydrochloric acid ethyl ether 0.4 mg, dexamethasone 3 mg 8:20 anaesthetic induction start: the use of intravenous midazolam 1.5mg, fentanyl 0.06mg, propofol 50mg, Shun aquukamto4mg, waiting for the patient's consciousness and autonomous breathing disappear, BIS value less than 50, give 2.5 throat cover insertion, connected anesthesia machine-controlled breathing 8:50 surgery, the operation uses propofol 20mL/h, riffintani 22mL/h, continuous pumping in, and adjusts the dose of the pumped drug according to BIS value and during operative conditions 10:20 Surgery is over, stop the anaesthetic pumping in 10:40 patients resume autonomous breathing, call, BP95/67mmHg, HR92 times / min, SpO2100%, give sputum removal throat cover The operation added 400mL to the ringer fluid, 20mL of bleeding, and stable vital signs At this time the face slightly red temperature is normal, the rest of the body skin color temperature is normal 11:00 Safety Ward, Monitor shows BP108/63mmHg, HR101 times/min, SpO2 99% 11:30 ward call to visit the patient, at this time the child's face and front chest skin redness, skin temperature is high, local no papules blisters and other diseases, the thermometer shows 38 degrees C At this time BP110/70mmHg, HR130 times / score, SpO299%, the child complains that the face feels hot, no skin pain, itching, slight pain at the surgical site, the rest of no discomfort Give dexamethasone 5mg into the pot to speed up the rehydration Observation for half an hour, did not see the patient's skin redness improved, the rest of the vital signs stable 13:00 visit patients, chest back skin returned to normal, face skin slightly red, body temperature 37.4 degrees C 13:30 visit the child, the whole body skin is back to normal, body temperature 37.4 degrees C One day after surgery, the patient was visited, and the vital signs were normal consider the side effects of acetate hydrochloride caused by skin redness, children in 2016-7-20, in the whole hemp downstream gypsum outside the fixed removal replacement, did not use acetate hydrochloride ether, other drugs did not change, the child did not appear tide red face cases 2, female, 6 years old, weight 13kg, height 105 cm, the main cause of "spastic cerebral palsy, double horseshoe inside the foot deformity" admitted to the hospital, intended in the whole hemp children cerebral palsy double lower limb muscle loose surgery, gypsum fixation The patient's preoperative examination of hemoglobin 108g/L was slightly lower than normal, and none of the remaining indicators were abnormal 2016-7-49:40 Patients enter the operating room, connected to electrocardiogram, BP92/55mmHg, HR89 times/min, SpO2 99% Open peripheral veins, conventional rehydration, intravenous pot to give hydrochloric acid ethyl ether 0.25 mg, dexamethasone 2 mg 9:50 anaesthetic induction start: use intravenous midazolam 1.5mg, fentanyl 0.05mg, propofol 30mg, Shun aqualku ammonium 3mg, waiting for the patient's consciousness and autobreathing disappear, BIS value is less than 50, give 2.5 larynx insert, connect the anaesthetic machine-controlled breathing 10:05 surgery began, the operation using propofol 15mL/h, riffini 12mL/h, continuous pumping, and according to BIS values and during operative conditions to regulate the pumping dose of the drug 10:50 Surgery is over, stop the anaesthetic pumping in 11:02 Patients resume autonomous breathing, call, BP100/70mmHg, HR110 times/min, SpO2 100%, give sputum removal throat cover In the operation to supplement the ringer liquid 300mL, bleeding 5mL, vital signs stable safely sent to the counter-ward at 11:20 13:00 Ward calls to visit patients, the child's face and chest back and upper abdomen skin red, high temperature, body temperature 38.2 degrees C At this time BP107/68mmHg, HR126 times / minute, SpO2 99%, children crying, restless Give dexamethasone 5mg into the pot, fentanyl 0.01mg, to speed up the rehydration Observation half an hour, the child's vital signs are stable, no longer crying, but the patient's skin redness has not subsided to improve, vital signs stable 15:00 visit to the child, the whole body skin is back to normal, body temperature 37 degrees C visited the patient one day after surgery, the vital signs are normal Consider that the child is the hydrochloric acid ethyle ether caused by tidal redness, in 2016-8-16 line gypsum removal replacement, reduce the amount of acetate hydrochloride ethyl ether, changed to 0.1 mg, the child did not appear tide red phenomenon 2 Discussion of acetyl hydrochloride ethyl ether as a new type of anticholinergic drug, through the blood-brain barrier, the central and peripheral have a strong anti-choline effect Can block acetylcholine on the toxic alkaloid receptor (M receptor) and intracranline receptor (N receptor) exciting effect, no obvious effect on M2 receptor, can effectively avoid atropine-induced tachycardia, and the drug effect is long and small side effects, can effectively inhibit the secretion of the glands, clinical widely used in the whole preoperative drug In this paper, 2 cases of children in the whole hemp induction were intravenously injected with acetate hydrochloric acid ethyle injection, after the use of conventional drug anesthesia, the children have facial and torso areas of the symptoms of redness and fever After the use of dexamethasone and the speed of the rehydration, there was no significant change in the redness of the child, so it was not considered to be a drug allergy These two patients were under second surgery within 2 months of the first operation, and the first case did not use the hydrochloric acid ethyl ether injection, and did not show the phenomenon of redness The second case of children reduced the use of preoperative hydrochloric acid ethyle ether, and there was no appearance of redness Therefore, considering that the presence of facial and torso moisture fever in these two cases is caused by intravenous drips of acetate ethyl ether injection healthy adult muscle injection 1 mg of acetate hydrochloride ethyl ether, 2 minutes in the blood can detect acetate hydrochloride, about 0.56 hours blood concentration peak, peak concentration of about 13.20 ?g/L, elimination of half-life of about 10.35 hours The two children in this paper were present in the intravenous injection 3-4 hours between the appearance of color and torso area of the red fever phenomenon, considering and the individual differences in children and the time of absorption of drugs And the drug has a longer half-life, easy accumulation, so children with tidal redness is not easy to subside Anticholinergic drugs have the effect of inhibiting hypothalamus activity, inhibiting the secretion of sweat glands, dilated peripheral blood vessels , resulting in increased heat dissipation the use of the latter color tide red in the specification of hydrochloric acid ethyl ether, but not common in clinical work, two cases of children in this paper are considered due to individual differences in the dose of the drug caused by the second case of children in the second operation to reduce the dose of the drug, there is no face moisture According to the literature, the dose of ethyl ether in children at 0.04 mg/kg can effectively inhibit gland secretion and reduce respiratory complications after surgery However, the children in this paper are children with cerebral palsy, long-term bed, height and weight are lower than the same age children , considering the child's self-development problems, for the regular dose of acetate acetanate an excessive reaction Therefore, the use of 0.02 mg/kg of a small dose of acetate hydrochloride as a pre-anaesthetic drug, for cerebral palsy and stunted children, more safe