[Convulsion following the combination of single preoperative oral administration of enoxacine and single postoperative intravenous administration of flurbiprofen axetil].
We experienced a case of convulsion following the combination of single oral administration of enoxacine before an emergency operation and single postoperative intravenous administration of flurbiprofen axetil. The patient was an 87-year-old female referred to our hospital for severe abdominal pain. She was diagnosed as having the strangulation ileus, then underwent the emergent operation of partial resection of the necrotic small intestine under general anesthesia. Unfortunately we did not know that she had temporarily received oral enoxacine 200 mg, a new quinolone, administered by the previous doctor on the day before the operation. After the operation, flurbiprofen axetil 50 mg, a nonsteroidal anti-inflammatory drug, was given intravenously in thirty seconds due to postoperative pain. One minute after administration of the drug, she immediately developed a convulsive fit, severe disturbance of consciousness and apnea. We then administered at once, a single dose of diazepam intravenously for convulsion treatment, kept her airway open and controlled her ventilation. Convulsion disappeared in a minute and her condition improved gradually. We suspect that convulsive seizure may have been induced by the drug interaction between single oral dose of enoxacine before the operation and single intravenous dose of flurbiprofen axetil after the operation. We also suspect that the serum concentration of enoxacine was kept high because of metabolic disturbance and renal dysfunction resulting from her old age and dehydration. This case suggests that medication before the emergency operation must be considered in anesthetic management because of the possible side effect such as convulsion induced by the drug interaction between neuquinolones and anti-inflammatory drugs.
Mizuno
J
J
Department of Anesthesia, Kochi Prefectural Aki Hospital, Aki 784-0027.
Sugimoto
S
S
Kaneko
A
A
Tsutsui
T
T
Tsutsui
T
T
Zushi
N
N
Machida
K
K
D000284:Administration, Oral; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D000890:Anti-Infective Agents / Q000009:adverse effects*; D015365:Enoxacin / Q000009:adverse effects*; D005260:Female; D005480:Flurbiprofen / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D012640:Seizures / Q000139:chemically induced*
D000700:Analgesics; D000890:Anti-Infective Agents; D015365:Enoxacin; D005480:Flurbiprofen