Abstract
Case and management：A 20-year-old, 27.3-kg man with cerebral palsy was scheduled for dental treatment under general anesthesia. Although the patient had had a swallowing disorder since infancy, he was given food orally; however, each meal required at least 2 hours and he often choked on his food. Secretions always pooled in his pharynx. Therefore, careful perioperative management was required in order to prevent aspiration pneumonia. The treatment was postponed five times because of the generally unsatisfactory status of the patient, and one year passed without treatment since his first dental consultation. On the day of treatment, his pharyngeal condition was good and his lungs were clear. Propofol was administered after suctioning of the pharynx. Mask ventilation and endotracheal intubation were performed uneventfully. Anesthesia was maintained using propofol and remifentanil, and intraoperative vital signs remained stable. Upon emergence from anesthesia, extubation was performed under adequate respiratory status. After full recovery from anesthesia, the large volume of secretions required frequent suctioning, and although breath sounds were bilaterally equal, rhonchi were audible. Thus, he was given nutrition intravenously for one night and was allowed to commence oral intake the next morning. After oral ingestion, the patient developed sudden fever and oxygen desaturation. Blood tests indicated signs of inflammation, in the form of an increased white blood cell count. Moist rales were heard over some areas of the lung. Since this was believed to be due to aspiration, antimicrobial therapy was started. Since continuing nutrition as he usually did at home was considered a priority, we continued oral intake. His general medical condition improved and the patient was discharged 4 days after treatment.
Discussion：Although we postponed anesthesia and dental treatment until the patient seemed to be in his best possible condition, aspiration pneumonia developed after anesthesia. In this case, significant symptoms were avoided by cooperation with pediatricians. Nutritional management in the perioperative period is an indispensable component of perioperative care. In cases such as this, it is necessary to choose an appropriate nutrition strategy after careful consideration of the level of dysfunction.
