The anaesthetic of benzene shunned the ammonium acumony to induce a silent chest.

Peng Hai, Wang Liyuan, Feng Ina, ChineseMIN Joint Security Force Tianjin Rehabilitation and Rehabilitation Center anesthesiology case patients, male, 55 years old, BMI24.8kg/m2, ASAII.class.
was admitted to hospital for 1 month due to upper abdominal discomfort, clinical diagnosis of the right groin hernia, the proposed laparoscopic groin groin repair.
patients found the right groin area swelling 1 month ago after manual labor, standing, walking when the swelling is obvious, flat after the swelling disappeared.
no fever in the course of the disease, no cough, cough sputum, good diet, sleep can be, size is normal.
Patients with coronary heart disease, myocardial isoemia for many years, intermittent oral compound dansin pills, denied diabetes, hypertension history, denied hepatitis, tuberculosis and other infectious diseases history, no smoking, drinking history, denial of drug, food allergy history.
: HR63 times/min, RR18 times/min, BP130/86mmHg, body temperature 36.3 degrees C.
Normal development, moderate nutritional status, the whole body skin did not see yellow dye, bleeding point, shallow lymph node tissue normal, chest profile without deformity, two-sided breathing degree is consistent, double lung buckle clear, listening to double lung breathing sound;
the abdomen flat, no peritina triple signs, normal intestinal chirping, no smell and air over the sound of water.
patients entered the operating room, HR80 times /min, BP140/70mmHg, RR18 times/min, SpO2 98%, non-invasional artery monitoring is normal.
intravenous infusion after anesthesia induction to give Mida zolun 2mg, propofol 70mg, the patient's eyelashes disappear, normal breathing, intravenous benzodiacium 14mg, injection time of 30s, after administration of the patient suddenly appear restlessness, Breathing difficulties, hand-controlled breathing resistance is greater, listening to double lungs without breathing sound, followed by patients HR gradually increased, BP200/110mmHg, gas resistance increased sharply, closed mask breathing difficulties, SpO2 performance decline, consider the upper channel Obstruction, to the mouth and pharynx ventilator to assist breathing, at this time the patient SpO240%, HR sexual progression slowed down to 40 times / minute, immediately intravenously to give Athosin 0.5mg, HR slowed down to 30 times / minute, BP, SpO2 monitoring can not, immediately The veins were given 0.1mg of epinephrine while the trachea tube controlled breathing was carried out under the visual laryngeal mirror, 24 cm of the 7.5 strengthening tube was inserted, the pressure of the vents after machine-controlled breathing was 40 cmH2O, PETCO2 was not shown, and hand-controlled breathing was carried out. Hearing double lung no breathing sound, continue to hand-held breathing immediately patients with decreased air resistance, VT200ml, gas channel pressure of 35 cmH2O, HR increased to 120 times / minute, BP180/ 100mmHg, SpO2 40%, 1min rear-machine-controlled breathing VT500ml, 14 times / sub-, air pressure of 18 cm H2O, BP145/90mmHg, SpO2 98%, PETCO2 60mmHg, stable vital signs of patients after rapid rescue treatment, continued observation in the operating room 1h, blood gas analysis examination: pH7.40, PCO2 40mmHg, PO2380mmHg, BE0.1, SpO29 8%.
Consider that this patient is due to the release of amphetamines caused by the release of benzodiamin caused by the silent chest, waiting for the patient to be aware, self-breathing recovery is good after the removal of the trachea intive, head MR examination did not see abnormalities, sent to the ward to continue observation.
4h after follow-up patients no discomfort reaction, re-confirm the patient's allergy history, the patient denied drugs, food allergies, after the consent of patients and family members to do drug allergy experiments, to determine that the allergen causing the patient's allergy is benzophon aquum.
The advantages of eliminating faster, histamine-free release in the body are widely used in clinical anesthesia because of its quick effect and small accumulation effect.
, when the body comes into contact with allergens, inflammatory media such as histamines and plateboard activation factors are released, triggering allergic reactions.
Although the increased dose of benzodiamin can shorten the starting time, but will cause histamine release, resulting in an allergic reaction in patients, and even directly threaten the life of patients, Yu Meiling and others believe that when the clinical dose of benzodiamin sulfonamide increased to 0.8mg/kg, the concentration of histamine in the blood will be significantly increased, patients can have allergic reactions, slow injection speed can reduce the release of histamine.
This case after giving Mida zolun and propofol no adverse reactions, after giving benzodiamolium 2min patients appear restlessness, tracheal spasms, listening to double lung no breathing sound and other adverse reactions, clinical judgment is benzodiacium acetic ammonium caused by severe bronchial spasms.
drug allergy tests conducted after the patient's vital signs were stable determined that the allergen that caused the allergic reaction in this patient was benzodiacium.
This case brings clinical experience and experience, (1) to strengthen preoperative prevention, clinicians should strictly grasp the adaptation certificate and taboo certificate of this product, should learn more about the patient's past allergy history, patients with a history of asthma should be careful to use benzodialycumam, because this product may increase the risk of bronchial spasms.
(2) for patients with a history of allergies and high reactive gas channels to carry out appropriate allergenic tests to reduce the occurrence of allergic reactions.
(3) preventive antihistamine medication before surgery can also reduce the degree of allergic reactions in patients.
(4) reasonably controlled the dose of ammonium benzodiacium and the speed of injection during anesthesia induction.
In summary, although the general dobenzene aquicum will not induce histamine release, but the drug has been reported to cause allergic reactions, with the increase in clinical application rate, the occurrence of allergic reactions also increased, anesthesiologists should be more vigilant about the allergic reactions caused by benzodiacium, once the drug appears allergic performance immediately stop the drug, to ensure the safety of patients.
sources: Peng Hai, Wang Liyuan, Feng Ina. A case of astrology induced by the anaesthetic of benzodialyculent induced silence in the chest, 2019 (07): 726. Journal of Clinical Anesthesiology Source: Clinical Anesthesiology Copyright Notice: All noted on this website"Source: May The text, images and audio-visual materials of SMM or Source: MedSci Originals are owned by Mace Medical and may not be reproduced by any media, website or individual without authorization, and shall be reproduced with the words "Source: Metz Medicine".
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