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Unanswered Response to Dexmedetomidine and Exaggerated Response to Propofol during Deep Brain Stimulation in Essential Tremor Case

机译:在原发性震颤病例中深部脑刺激过程中对右美托咪定的无应答反应和对异丙酚的夸张反应

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Background: In our case we discussed the sedation made with dexmedeto-midine unresponsiveness and exaggerated response to propofol of patients with essential tremor. Case: 75 years old, male, without any co-existing disease, with essential tremor patient, planned deep brain stimulation operation under sedoanalgesia, one week before the operation the patient evaluated and was planned to perform brain magnetic resonance imaging (MRI) under sedation in the MRI unit. We performed sedation with fractional doses of 20 mg propofol than maintained the propofol infusion 0.5-1 mg/kg/hour. At the 20th minute the propofol infusion was stopped on the dropped of the patient’s blood pressure at 50/35 mmHg. After 20 mg efedrin was given intravenously, blood pressure was achieved to the basal levels in one minute. One week after we performed MRI and we gave only half dose of first time. Sleeping pattern analysis for obstructive sleep apnea or sleeping disorders was done for this patient. On the DBS day we decided to perform the procedure with dexmedetomidine. Initial bispectral index values 98%-99% (BIS aspect). After 20 minute neither BIS values, nor Ramsey changes. We maintained high doses dexmedetomidine but it didn’t worked, so we turned to propofol on 30th minute and after we performed 10 mg propofol, BIS values was 85%-88% throughout the operation. We gave 40-50 mg propofol totally throughout the procedure and RSS was 3-4. Discussion: Unresponsiveness of dexmedetomidine that we faced in our case may be by neurodegeneration of locus coeruleus and we could explain this exaggerated response to propofol of this patient on GABA receptor increased intensity.
机译:背景:在我们的案例中,我们讨论了右旋美托咪啶无反应性和对本质震颤患者对丙泊酚的过大反应的镇静作用。病例:75岁,男性,无任何共存疾病,伴有原发性震颤患者,计划在Seedanan镇痛进行深部脑刺激手术,手术前一周评估患者并计划在镇静下进行脑磁共振成像(MRI)在MRI单元中。我们以20 mg异丙酚的小剂量进行镇静,而不是维持0.5-1 mg / kg /小时的丙泊酚输注。在第20分钟,当患者的血压下降至50/35 mmHg时,停止输注丙泊酚。静脉注射20毫克efedrin后,在一分钟内血压升至基础水平。进行MRI一周后,第一次只给了一半剂量。对该患者进行了阻塞性睡眠呼吸暂停或睡眠障碍的睡眠模式分析。在DBS那天,我们决定使用右美托咪定进行该操作。初始双光谱指数值98%-99%(BIS方面)。 20分钟后,BIS值和Ramsey均未更改。我们维持高剂量右美托咪定,但没有效果,因此我们在第30分钟转向丙泊酚,并在执行10 mg丙泊酚后,整个手术过程中BIS值为85%-88%。在整个过程中,我们总共给予40-50 mg异丙酚,RSS为3-4。讨论:在我们的病例中,右美托咪定的无反应性可能是由于蓝斑所在地的神经变性引起的,我们可以解释这种患者对丙泊酚对GABA受体增加强度的过度反应。

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