2014 年 33 巻 1 号 p. 10-12
Pulmonary aspiration of gastric contents during induction of anesthesia is a serious complication. A 61-year-old male who had previously undergone esophagectomy, was scheduled resection of hypopharyngeal tumor under endoscopy. He was directed to abstain from food 16 hours and clear liquids 4 hours, respectively, before entering the operating room. Just after loss of consciousness on injection of propofol, the patient coughed before bag-mask ventilation, and administration of a volatile anesthetic and a neuromuscular blocking drug. As pulmonary aspiration was suspected, tracheal intubation was performed at once without the use of a neuromuscular blocking drug. Just after tracheal intubation, a large volume of brownish liquid was discharged through the tracheal tube with cough reflex, and the liquid was immediately removed. Arterial blood gas analysis showed hypercapnia without hypoxia. After operation, the patient was not extubated and aminophylline was administered, because hypercapnia persisted postoperatively. Because PaCO2 gradually decreased to normal range after administration of aminophylline, the patient was extubated 18 hours after induction of anesthesia. In conclusion, a patient with a past history of esophagectomy is likely to be at high risk of pulmonary aspiration during induction of anesthesia irrespective of 16 hour-preoperative fasting.