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.
コンパートメント症候群は，筋区画内圧測定により診断・治療を行う。筋区画内で適切な血液の潅流によって酸素運搬が行われることが重要であり，そのモニターとして，近赤外線分光法（near-infrared spectroscopy：NIRS）により筋区画内の局所酸素飽和度（regional saturation of oxygen：rSO2）を測定することは，理にかなった方法である。減張切開が必要となったコンパートメント症候群で，筋区画のrSO2を測定したところ低値を示した２症例を経験した。減張切開の適応判断に，NIRSが有用となる可能性がある。