気管挟窄症を伴う知的障害患者に対し経鼻高流量療法併用静脈内鎮静法で管理した1例

DOI
  • 伊藤 孝哉
    東京医科歯科大学大学院医歯学総合研究科歯科麻酔・口腔顔面痛制御学分野 埼玉県立あさか向陽園障害者歯科診療所
  • 脇田 亮
    東京医科歯科大学大学院医歯学総合研究科歯科麻酔・口腔顔面痛制御学分野
  • 安藤 寧
    埼玉県立あさか向陽園障害者歯科診療所
  • 深山 治久
    東京医科歯科大学大学院医歯学総合研究科歯科麻酔・口腔顔面痛制御学分野

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タイトル別名
  • A Case of Intravenous Sedation in Combination with Nasal High Flow Therapy in an Intellectually Disabled Patient with Tracheal Stenosis

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<p>  Nasal high flow therapy (NHFT) is a non-invasive respiratory therapy used to maintain a high fraction of inspired oxygen (Fio2) by delivering a mixture of high-flow oxygen and air. This technique has several physiological advantages compared with other standard oxygen therapies, including a reduced anatomical dead space, a positive end-expiratory pressure, and sufficient humidification. NHFT is attracting attention as an alternative respiratory support therapy for critically ill patients.</p><p>  Here, we report the maintenance of intravenous sedation using NHFT during a dental treatment in an intellectually disabled patient with tracheal stenosis. The patient was 148 cm tall, weighed 40 kg, and had a history of cardiac surgery for a double-outlet right ventricle. He suffered from tracheal stenosis caused by the long-term placement of a tracheal tube after an operation. No abnormalities were noted during a cardiac evaluation, including an echocardiogram and an electrocardiogram. Chest computed tomography showed the stenosis of the main bronchus, resulting in a diameter of only 6 mm at the narrowest point. For this reason, we considered that tracheal intubation during general anesthesia might carry a risk of airway stenosis, and we decided to maintain the intravenous sedation using NHFT without other active airway managements.</p><p>  The sedation was induced and maintained using midazolam and propofol. After an optimal sedation level was achieved, we inserted a nasal cannula for NHFT under an Fio2 setting of 0.4 and a flow of 30 l/min. When an upper airway constriction occurred because of an increased anesthetic depth or the depression of the mandible, we increased the NHFT flow to 40 l/min and performed a jaw-lift maneuver. The Spo2 remained stable under spontaneous respiration throughout the operation. A few minutes after the end of the use of the sedatives, voluntary movements were observed. Neither respiratory depression nor hemodynamic compromise was observed postoperatively. We suggest that intravenous sedation with NHFT could be a safe and effective method for preventing airway obstruction in patients with tracheal stenosis and might also be applicable for patients with intellectually disability.</p>

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