蘇生
Online ISSN : 1884-748X
Print ISSN : 0288-4348
症例報告
Severe aspiration pneumonitis in a patient without risk factors duringmonitored anesthesia care for a brief manipulation : A case report
Yamaguchi Satoshi
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2018 年 37 巻 2 号 p. 66-71

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In general, pulmonary aspiration during anesthesia can occur in patients who have several risk factors. The practical reports of risk-free cases during short periods of light sedation or monitored anesthesia care (MAC) are limited. Herein, a 60-year-old healthy male patient underwent brief manipulation under MAC, preceded by preoperative fasting. He had no risk factors for aspiration. The procedure was completed in 10 min under MAC using 100 mg of propofol and temporary 2-3% sevoflurane, without the airway securing. Prior to awakening, he vomited a small amount of gastric contents. His respiratory state was stable 30 min after that. However, 60 min later, he developed aspiration pneumonitis. His respiratory condition deteriorated rapidly, and 150 min later, he developed acute respiratory distress syndrome (ARDS). In addition to mechanical ventilation as a lung protective strategy, methylprednisolone, sivelestat sodium, and antibiotics were administered continuously. The following day, the patient showed a marked improvement. In conclusion, MAC during a brief surgical procedure like using 100 mg of propofol and 2-3% sevoflurane without the airway securing can be a serious risk factor of perioperative regurgitation and pulmonary aspiration, even if a risk-free patient follows the preoperative fasting procedure. In addition, even if patient's condition is stable immediately after aspiration, aspiration pneumonitis may occur for a short time and deteriorate to ARDS rapidly.Key words : Aspiration pneumonitis, Pulmonary aspiration, Monitored anesthesia care

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