One case of upper respiratory tract obstruction after all-hemp in Parkinson's disease
Last Update: 2020-06-16
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Patient, male, 74 years old, 158cm, 67kg, diagnosis: prostate hyperplasia, intended in general anesthesia downstream through the urethra prostate airbag dilationAfter 2 years of Parkinson's disease, long-term regular use of dopasystablets, zoca double dopa and other anti-Parkinson drugs until before surgeryTake 250mg of dopasy tablets at 07:00 on the day of the operationDenied the history of hypertension, diabetes, asthma and so on, no recent fever, cough, coughing sputum symptoms, smokeless wine historyLaboratory tests are in the normal range, electrocardiogram did not see abnormalThe echocardiogram suggests that the left ventricle function is reduced and the mild two-tip valve is not completely closedChest tablets suggest aortic aortic heart, aortic atherosclerosisA lung function check indicates mild restrictive ventilation disorder and mild dispersal dysfunctionThere is no abnormality in the skull CTPatient11:45 admission, RR15 times/min, HR72 times/min, BP190/82mmHg, SpO296%, arterial blood gas index is normalFull hemp induction: Dexametason 10mg, Meda-Len 2mg, Fentanyl 02mg, relying on miede 20mg, shun aquku ammonium 15mgThe mask was ventilated smoothly and inserted smoothly through the mouth 7The No5 trachea duct is mechanically ventilatedDuring the operation, 1% heptafluoroetherine was continuously inhaled, and the intravenous pump was injected with propofol and riffintani was maintained with anaesthetic The operation lasted 30min and went smoothly Patients 13:10 transferred to PACU, after the removal of the trachea catheter with shortness of breath, irritability, detection of three concave signs obvious, SpO2 gradually dropped to 89%, in line with the upper respiratory tract obstruction performance To the jaw, mask pressure to oxygen, but the airway resistance is greater, auxiliary breathing is not satisfied, the above symptoms did not improve To be sedated propofol, visual laryngoscope direct lying to remove secretions, sound door spray 2% Lidocain When the patient's self-breathing disappears, the wheezing stops, the wheezing sound reappears after the recovery of the autonomous breathing, the sound door is closed when the inhaler is visible under the laryngoscope, and the sound door opens when exhaling Repeat the above treatment, the patient wheezing and three concave signs did not see relief, re-run tracheal intubation After 1h the patient is conscious, the trachea catheter is removed, and the symptoms of upper respiratory obstruction reappear Otolaryngology emergency consultation, consider vocal cord paralysis, recommended trachea incision, family refused, again line trachea intubation Comprehensive analysis of medical history, considering that stubborn upper airway obstruction after the tube extraction may be related to the original onset and drug discontinuation, then at 19:00 nasal feeding dopabasilla tablets 250 mg After 1h removal of the trachea catheter, the symptoms of upper respiratory tract obstruction improved, spO2 97% in oxygen absorption state, review of arterial blood gas pH7 39, PCO2 44mmHg, PO2 96mmHg 20:20 Oral dopasyre tablets 250mg again Observe the patient's condition stable and return to the ward The next day's return visit, the patient's breathing difficulties symptoms and wheezing are significantly reduced Follow the medical history, the patient diagnosed Parkinson's disease 1 year later due to conscious pronunciation weakness, mild voice hoarse in the otolaryngology department, by laryngoscope examination diagnosed as two-sided vocal band paralysis, because the symptoms are lighter, not treated Discuss Ingandisease is a chronic neurodegenerative disease that is most common in elderly patients, and its pathological characteristics are the loss of a large number of dopamine neurons in black matter, the formation of Lewy body, and clinically characterized by limited motor system function, such as retardation, muscle stiffness, static tremor, etc Upper respiratory obstruction is not common in patients with Parkinson's disease, and literature reports may be related to vocal cord paralysis, throat spasms, abnormal muscle muscle tone in the lower jaw and neck Two-sided vocal band paralysis is the most common cause, mainly manifested in wheezing, shortness of breath and breathing difficulties, visible vocal cord movement disorders under the laryngoscope, more urgent line trachea intubation or trachea incision to save lives The pathogenesis mechanism is not clear, considered to be related to the high muscle tone of the throat or suspected nuclear degeneration, the intralarmuscular dysfunction In this case, patients have two-sided vocal band paralysis before and after surgery, but no drinking water cough, no obvious wheezing and breathing difficulties symptoms, sedative state mask ventilation is good, suggesting that the patient's two-sided vocal cord paralysis symptoms are light, is not the main cause of the upper respiratory obstruction Throat spasms occur mostly after the extraction of tubes, is a common complication of the perinatal period, is also the second common cause of Parkinson's disease combined with upper respiratory obstruction, can exist with double-sided vocal cord paralysis, literature reports that airway stimulation may induce larynx spasms, drug acute withdrawal may cause airway obstruction, drug treatment is not sufficient to cause persistent larynx spasms, adjustthed drug dose can alleviate symptoms Medication is the primary tool for Parkinson's disease, and lvocyclopaal or dopamine receptor agonists are the cornerstones of the treatment of Parkinson's disease The half-life of the left-handed dopa is 1 to 3h, the patient's surgery on the day of 07:00 to take dopasytablet sashimi tablets 250 mg, after surgery the tube from the last drug nearly 7h, during the period did not supplement the drug, the drug concentration is obviously insufficient, may be the main cause of persistent laryst spasms 19:00, 20:20 twice to dopasion tablets 250 mg, the upper respiratory tract obstruction symptoms gradually improved, the condition tended to stabilize, avoidtrachebopenct After returning to the ward to restore the original drug treatment, the next day breathing difficulties symptoms and wheezing significantly reduced, suggesting that the patient's postoperative upper respiratory obstruction may be related to the acute reduction of anti-Parkinson drugs caused by persistent larynx spasms Preoperative visit and medical history collection is the best way to detect the risk of potential upper respiratory obstruction and avoid adverse events during the perioperative period of Parkinson's disease, and should be asked in detail whether such patients have hoarse changes, coughing in drinking water, breathing difficulties, the presence of the above symptoms should be preceded by otolaryngology consultation For patients with Parkinson's disease surgery, the appropriate anaesthetic method should be selected after comprehensive assessment according to the site, time, difficulty, perioperative risk and the patient's personal wishes The use of anti-Parkinson disease drugs in the perioperative period should pay attention to the following points: (1) left-handed dopa short-lived, stop time should not be too long, the early morning before surgery should be adhered to, early recovery after surgery; Airway management of all-hemp patients should be careful, after the tube is closely observed, alert to the appearance of upper respiratory obstruction, analysis of the cause, active treatment, threatening the life of patients should be urgent trachea incision In summary, for patients with Parkinson's disease who have the risk of upper respiratory tract obstruction during the perioperative period, the medical history should be fully assessed before surgery, the risk should be fully assessed, the anaesthetic method should be reasonably selected, the perioperative period is closely observed, and the treatment is ensured to ensure the safety of the patient's life
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