全身麻酔下で生検手術中にガス交換不全に陥った前縦隔腫瘍の1例 Severe Gas Exchange Insufficiency during Biopsy of a Mediastinal Tumor Under General Anesthesia
A 19-yr-old man with a large anterior mediastinal tumor underwent for diagnostic biopsy surgery under general anesthesia before the start of chemotherapy. Anesthesia was induced with propofol and fentanyl and the trachea was intubated after administration of vecuronium. Anesthesia was maintained with propofol and fentanyl in 100% oxygen. After intubation, the respiratory sounds of the left lung were not audible. About 60min later, the peak airway pressure gradually increased and SpO<sub>2</sub> decreased. Although the endotracheal tube was advanced beyond the stenotic portion of the trachea, this treatment did not increase SpO<sub>2</sub> in spite of dramatic improvement in ventilation. As SpO<sub>2</sub> was decreasing to less than 50%, the operation was discontinued and the use of PCPS was decided. Epinephrine was administered because his heart rate decreased to 40beats/min. After the start of PCPS, SpO<sub>2</sub> increased to more than 90% and circulatory stability was recovered. Cardiac angiography revealed complete obstruction of the right pulmonary artery and a left pulmonary artery with no signs of compression. These lead us to the conclusion that complete compressive obstructions of both the left main bronchus and the right pulmonary artery due to a large mediastinal tumor occurred simultaneously, resulting in severe gas exchange insufficency.
- 日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia
日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 23(9), 276-279, 2003-11-15
THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA