先天性右肺欠損症および左気管支狭窄を伴う知的障害患者の智歯抜歯に対する全身麻酔経験

抄録

  We report the use of general anesthesia in an intellectually disabled patient with right pulmonary agenesis and left bronchial stenosis. A wisdom tooth extraction was performed under general anesthesia in a 17-year-old female weighing 45 kg. Preoperative chest radiography and computed tomography (CT) showed a tracheal deviation and bronchial stenosis of the left main bronchus, respectively. The bronchial stenosis caused the patient to experience stridor and respiratory instability during respiratory efforts. Upon the patient’s entrance to the operating room, gasping respiration and stridor were observed. Prior to the nasotracheal intubation, the patient’s irregular respiration was controlled with oxygen and the slow induction of anesthesia with sevoflurane. The location of the tracheal tube’s distal opening was confirmed using a bronchofiberscope. The anesthesia was maintained using propofol and remifentanil. Thirty minutes after the start of surgery, 1 μg/kg of dexmedetomidine hydrochloride (DEX) was administered over a period of 10 minutes and DEX administration was then continued at a dosage of 0.4 μg/kg/h to prevent agitation during recovery from anesthesia. The patient was sedated following extubation and, in the absence of any observed respiratory difficulties, the administration of DEX was stopped after 5 minutes. The patient’s Observer’s Assessment of Alertness/Sedation (OAA/S) score was 3 upon her return from the operating room, increasing to 4 and then 5 at 30 minutes and 1 hour after surgery, respectively. No abnormalities were observed in the patient’s overall status after surgery, and the patient was discharged on the following day. By using preoperative CT to ascertain the airway morphology, confirming the tracheal tube location using bronchofiberscopy, and administering DEX for postoperative sedation, successful anesthesia was managed without the induction of stridor or respiratory difficulties.