頚椎前方手術後の気道閉塞予防におけるファイバースコープの有用性

Clinical Utility of Direct Fiberoptic Evaluation of the Upper Airway Before Extubation as a Means of Preventing Airway Obstruction after Anterior Cervical Spine Surgery

　背景：今回われわれは，9例の頚椎前方手術症例を対象として気道閉塞予防におけるファイバースコープの有用性を調査した．

　対象と方法：手術時平均年齢は52歳であった．前方アプローチ単独は7例，前方後方併用アプローチは2例であった．単椎間固定は4例，複数椎間固定は5例であった．手術翌日以降にファイバースコープによる咽喉頭の評価を行い，抜管の可否を決定した．

　結果：手術翌日は2例で強い咽喉頭の腫脹を認めたために抜管が延期となった．9例とも抜管後の気道合併症を生じなかった．

　まとめ：ファイバースコープによる咽喉頭の評価は気道閉塞の予防に有用である．

　Background：We retrospectively reviewed the clinical utility of direct fiberoptic evaluation of the airway before extubation in nine patients who had undergone anterior cervical decompression and fusion.

　Methods：Mean age at surgery was 52 years (33-80).　An anterior approach alone was used in seven patients, and a combined anteroposterior approach in two patients.　Single-level fusion was performed in four of the nine patients, and multilevel fusion was performed in the other five patients.

　Outcome：All patients remained intubated overnight.　Extubation was performed on postoperative day (POD) 1 or later, when fiberoptic evaluation confirmed healing of reactive tracheal and vocal cord swelling.　Seven patients were extubated on POD 1, but extubation was delayed in the other two patients, one of whom had undergone single-level fusion, because of upper airway swelling.　None of the nine patients required reintubation or tracheostomy.

　Conclusion：Based on the results of this study we recommend fiberoptic confirmation of adequate healing of reactive tracheal and vocal cord swelling before extubation of patients who have undergone anterior cervical spine surgery.