Dandy-Walker症候群患者の全身麻酔経験

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  • General anesthetic management of a patient with Dandy-Walker syndrome

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Dandy-Walker syndrome is characterized by perfect or partial defect of the cerebellum vermis and cystic dilatation of the posterior fossa communicating with the fourth ventricle. We used general anesthesia for comprehensive dental treatment in a case with this syndrome who had a ventriculo-peritoneal (VP) shunt. The patient was a 3-year-old boy diagnosed with Dandy-Walker syndrome at 5 months after birth. A VP shunt was inserted into the lateral ventricle and the cyst on the posterior fossa at 10 months. After the VP shunt operation, there were no symptoms of cerebellum dysfunction or increased intracranial pressure. A diazepam suppository (6mg) was administered 90 minutes before the start of anesthesia. After the establishment of a venous route, anesthesia was induced with thiopental sodium (100mg) and nasotracheal intubation was facilitated with vecuronium bromide (2.5mg). Ventilation with a face mask and laryngoscopy were performed without difficulty. Anesthesia was maintained with oxygen (2l/min), nitrous oxide (4l/min) and sevoflurane (1～2%). Prostheses after pulpectomy in 4 teeth and composite resin filling in 4 teeth were performed and the anesthesia was over uneventfully after 3 hours and 35 minutes. There were no postoperative complications such as vomiting, disturbance of consciousness and ataxy. There are several problems with the management of this syndrome, such as avoidance of embedded shunt-valve dysfunction by magnetic fields such as in MRI exposure, and by external force, choice of anesthetic that has less effect on cerebral pressure, and maintenance of adequate respiratory condition during operation and postoperative period.

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  • 松本歯学

    松本歯学 29 (3), 268-271, 2003-12-31

    松本歯科大学学会

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