2 cases of deactivation of right metomyte immediately after the use of PCIA led to reports of severe respiratory suppression.

!--ewebeditor:page title"--right metomy is a highly selective alpha2-adrenaline-perpentinator with central anti-cross-exchange and anti-anxiety effects, which can produce sedative effects similar to natural sleep;
is now widely used in in-sedative sedation and postoperative analgesics, diagnostic operation of sedation and other evidence of adaptation, there are literature reported that the right metomyde in the blood drug concentration reached a significant sedative effect, will reduce the amount of moisture, but the breathing frequency and exhalation of carbon dioxide changes are not obvious.
suggests that there may be a risk of respiratory suppression.
2 cases of severe respiratory suppression in our hospital using right metomynation and immediately after using patient controled intravenous analgesia (PCIA) are reported below.
1. Clinical data The number of operations in our hospital from January to March 2017 was 5911, 1300 cases were treated with postoperative analgesy, and 2 cases of severe respiratory inhibition occurred.
patient 1, female, 48 years old, body mass 65kg, height 160 cm, medium size, in epidural anesthesia (L1.2 puncture, given the experimental dose after giving 2% Lidokain 7mL and 1% Rocardin 5mL, anaesthetic plane control in T10 to S2) hysterectomy, no special medical history, preoperative blood routine, clotting function, electrolyte, liver and kidney function, electrocardigram, chest and other examinations no obvious abnormalities.
use of right metomiding continuous pump injection (0.62 μg/(kg.h)), the operation lasts about 1.5h, the operation ends with the deactivation of the right metomidan, wake up the patient to check the patient's anaesthetic plane and blood pressure again, immediately return the patient to the general ward, after the operation analgesic pump did not give oxygen absorption monitoring The formulation of the analgesic pump is Shufenthani 2.5 μg/kg plus hydro morphine 0.04mg/kg plus Glasjon 6mg plus physiological saline, a total of 200mL, analgesic pump for mechanical pump, no first dose, continuous amount 4mL/h, additional amount 1mL, locking time 15min.
patient returned to the ward about 20min after loss of consciousness, respiratory arrest, can touch the cervical artery throbbing, after the patient immediately appeared cardiac arrest, after the rescue of the patient's heartbeat recovery, but left ischemia isooxygen encephalopathy.
patient 2, female, 58 years old, body mass 69kg, height 156 cm, body fat, neck short, in the cobweb subcavity anaesthetic (L3.4 puncture, cobweb subcavity to give 0.75% rodicin 3mL, anaesthetic plane T10 below) down the line inside and outside Ankle fracture cut-off reset internal fixation, abdominal B super prompt Buga syndrome, spleen, patients preoperative blood routine prompt platelets 65 x 109 / L, the rest of the examination of clotting function, electrolytes, liver and kidney function, electrocardia, chest tablets and other items are no obvious abnormalities, patients have sleep apnea syndrome.
the use of right metomyte continuous pump injection ( 0.53 μg / (kg.h)), the operation lasts about 1.5h, the end of the operation deactivation of the right metomyte, wake up the patient to check the patient's anaesthetic plane and blood pressure, immediately after the patient Returned to the general ward, analgesic pump formula and parameters with patient 1, after the operation analgesic pump was not given oxygen monitoring, sent back to the ward about 25min, the patient lost consciousness, breathing stopped, can touch the cervical artery throbbing, after rescuing the patient consciousness, respiratory recovery, no complications left.
2. Discussion 2 patients reported to have intravertebral anaesthetic sensory block plane below T10, and check the anaesthetic plane again when out of the operating room, will not cause respiratory inhibition due to anaesthetic plane causes.
patient's intravenous medication is only right metomy, postoperative respiratory inhibition should be associated with the drug, but postoperative analgesics can not be completely ruled out respiratory inhibition.
researchers believe that the mild inhibition of breathing by right metomy is caused by the inhibition of the central nervous system.
literature, there have been only 3 reports of apnea or severe respiratory suppression caused by right metomydding, which are rare adverse reactions.
Right metomy set the effective time of 10 to 15min, peak time of 25 to 30min, the end of the removal of half-life (t1/2) about 2h, the vertebral tube anesthesia will give the patient oxygen absorption, mild respiratory inhibition is possible, the 2 patients immediately after the suspension of the drug returned to the ward and did not give oxygen monitoring, the patient may again appear sedative action leading to respiratory inhibition.
In this way, after these two respiratory suppression events, my hospital requested that the right-hand mitomi be deactivated for 30min before the patient could be sent back, and the patient needed oxygen monitoring 2h when he returned to the ward to avoid such adverse events.
The recommended dose range for anaesthetic sedation in the vertebral tube is 0.2 to 0.7 μg/(kg.h), and although the dose of the drug in the 2 patients is within this range, it is close to the upper limit of the range, and the 2nd patient has Buga syndrome and cirrhosis of the liver.
the respiratory suppression in these 2 cases may be related to the larger dose of the drug, and current studies also suggest that the side effects such as respiratory inhibition are be more pronounced with the increase in the dose used or the rapid infusion.
this, after these two respiratory suppression events, my hospital asked the right metomydding sedative dose of the anaesthetic patient in the vertebral tube to be reduced to 0.2 to 0.4 sg/(kg.h).
problems with respiratory suppression caused by opioids are often reported.
This 2 patients received analgesic pump time is short, enter the drug less than 2mL, enter the patient's body analgesic drug volume is small, but the analgesic pump formula for 2 kinds of strong opioid drugs, are both s-subjectors, and both drugs have a risk of respiratory inhibition, the 2 patients breathing inhibition and postoperative analgesic synergy is still debatable.
not recommended for the simultaneous use of opioids with the same action time and acting on the same or mutual antagonists.
the lessons of these two respiratory suppression events are that they are not matched with two powerful opioids for postoperative analgesm.
In summary, although there are few reports of respiratory inhibition caused by right metomyn, but from clinical practice observation also found that patients calmly fall asleep after the tongue drop obviously, pay attention to the drug dosage and inoperative, postoperative close monitoring is a reasonable and safe use of the drug guarantee.
patients who need an analgesm pump after surgery should be closely monitored after surgery.
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