4度目の口腔外科手術の全身麻酔を契機に, 小児期発症バセドウ病と診断された1症例

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  • A Case of Childhood-onset Basedow-Graves’ Disease Diagnosed as a Result of a Fourth Application of General Anesthesia for Oral and Maxillofacial Surgery

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<p>  Childhood-onset Basedow-Graves’ disease is a rare disease with an incidence of 5%. We report a case of childhood-onset Basedow-Graves’ disease that exhibited tachycardia at the time of a preoperative physical examination and subsequently presented with delirium, tachycardia, nausea, and vomiting during the postoperative period after a fourth application of general anesthesia.</p><p>  The woman (age, 16 years and 3 months) had undergone surgery under general anesthesia on three occasions for the correction of a unilateral cleft lip and palate. No abnormalities were detected during the previous perioperative periods. A secondary unilateral chelioplasty and nose repair under general anesthesia were scheduled.</p><p>  A preoperative physical examination performed one month before the currently reported surgery showed no abnormal values except for sinus-rhythm tachycardia (106 beats/min). Although her heart rate was 155 beats/min at the time of admission, her heart rate decreased and stabilized to a range of within 85-105 beats/min while under general anesthesia. However, her heart rate suddenly increased to 165 beats/min and the patient developed delirium, sweating, shivering, and systemic redness during the discharge period after anesthesia. Five minutes after extubation, the redness disappeared and her blood pressure decreased to 140/80 mmHg ; however, the patient’s nausea and anxiety persisted for 30 hours. Consequently, we consulted the Department of Internal Medicine regarding the patient’s thyroid function. The patient was diagnosed as having childhood-onset Basedow-Graves’ disease and was orally treated with thiamazole and bisoprolol fumarate. The patient was discharged two days after the start of pharmaceutical treatment after exhibiting a decrease in her heart rate and the disappearance of anxiety.</p><p>  Preoperatively, the patient exhibited poor subjective symptoms of Basedow-Graves’ disease ; therefore, the disease could not be diagnosed preoperatively in this patient. Subsequently, the patient developed thyrotoxic storm-like symptoms postoperatively. Therefore, undiagnosed tachycardia with an onset ranging from childhood to adolescence might be a useful clue in screening for undiagnosed Basedow-Graves’ disease.</p>

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