抗ミトコンドリア抗体陽性筋炎患者に対する腹腔鏡下S状結腸切除術の麻酔経験

Anesthetic Management of a Patient with Myositis Associated with Antimitochondrial Antibodies for Laparoscopic Sigmoidectomy：A Case Report

要旨

　抗ミトコンドリア抗体（antimitochondrial antibody：AMA）陽性筋炎による呼吸筋の筋力低下を認める患者に対して，腹腔鏡下S状結腸切除術の麻酔を経験した。術前から呼吸器リハビリテーションを開始し，胸部硬膜外麻酔併用全身麻酔下に手術を施行した。筋弛緩薬に対する感受性亢進と効果遷延が懸念されたが，筋弛緩モニターを用いることで安全に管理できた。

　A 54-year-old woman with a history of myositis associated with antimitochondrial antibodies（AMA）was scheduled to undergo laparoscopic sigmoidectomy. Preoperative spirometry revealed a severe restrictive respiratory defect that was associated with limited daily activity due to exertional dyspnea and the need for home oxygen therapy. We planned volatile anesthesia combination with thoracic epidural anesthesia, increment administration of rocuronium under neuromuscular monitoring, administration of an adequate dose of sugammadex, and perioperative respiratory rehabilitation. The operation and weaning from mechanical ventilation were performed without any significant issue. We demonstrated that AMA-associated myopathy could be managed without any pulmonary complications and exacerbation of the myositis.