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

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著者

    • 植田 一吉 UETA Kazuyoshi
    • 大阪大学大学院医学研究科生体機能調節医学講座 Department of Anesthesiology, Osaka University Medical School
    • 内田 一郎 UCHIDA Ichiro
    • 大阪大学大学院医学研究科生体機能調節医学講座 Department of Anesthesiology, Osaka University Medical School
    • 高階 雅紀 TAKASHINA Masaki
    • 大阪大学大学院医学研究科生体機能調節医学講座 Department of Anesthesiology, Osaka University Medical School
    • 上山 博史 UEYAMA Hiroshi
    • 大阪大学大学院医学研究科生体機能調節医学講座 Department of Anesthesiology, Osaka University Medical School
    • 真下 節 MASHIMO Takashi
    • 大阪大学大学院医学研究科生体機能調節医学講座 Department of Anesthesiology, Osaka University Medical School

抄録

全身麻酔下で生検手術中に致命的な呼吸循環不全に陥った巨大前縦隔腫瘍の症例を経験した.麻酔導入時より呼吸音から左気管支の閉塞が認められた.麻酔開始1時間後より気道内圧の上昇と酸素飽和度の低下が起こり,気管狭窄部を越えてチューブを進めると換気の改善はみられたが酸素飽和度は上昇しなかった,酸素飽和度が50%台に低下したため経皮的人工心肺補助(PCPS)の準備を開始した.血圧低下と徐脈にはエピネフリンの大量投与で対応した.PCPS開始により呼吸循環動態が安定した後,心臓カテーテル検査を施行したところ右肺動脈の完全閉塞が認められた.腫瘍による圧排のために左主気管支と右肺動脈の完全閉塞が起こり,ガス交換不全に陥ったと判断した.

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.

収録刊行物

  • 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

参考文献:  7件中 1-7件 を表示

被引用文献:  2件中 1-2件 を表示

キーワード

各種コード

  • NII論文ID(NAID)
    10012548604
  • NII書誌ID(NCID)
    AN00330159
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    02854945
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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