髄液減少症妊婦の硬膜外麻酔で局所麻酔薬の髄液移行が疑われた1症例

A Case of Suspected Local Anesthetic Migration into the Cervical-level Cerebrospinal Fluid after Epidural Anesthesia for Cesarean Section in a Woman with Cerebrospinal Fluid Hypovolemia Syndrome

要旨

　髄液減少症の患者で，腰部硬膜外麻酔注入直後に反応消失と呼吸停止を生じたが，4分後に自発呼吸と応答が回復した。術後の聴取で，硬膜外麻酔注入後に手指の不動から呼吸困難に至ったが，意識は保たれていたと判明した。経過と磁気共鳴画像（magnetic resonance imaging：MRI）の所見から，硬膜外に注入した局所麻酔薬の一部が頸部の硬膜損傷部からくも膜下に流入した可能性が考えられた。

　Immediately after epidural anesthetic injection for cesarean section in a woman with cerebrospinal fluid hypovolemia syndrome, loss of responses and respiratory arrest occurred. After 4 min, spontaneous breathing and responses recovered. Postoperative interview revealed that the woman’s fingers had become immobile and dyspnea had developed after the epidural injection while she was conscious. The clinical course and MRI findings, including intradural fluid at C7 and epidural space widening, suggested that some of the epidurally injected local anesthetic had flowed into the subarachnoid space through the injured dura at the cervical spine, causing transient signs similar to those of total spinal anesthesia.