扁桃摘出術と軟口蓋形成術を延期し肥満手術を先行させた病的肥満患者の麻酔管理

Anesthetic Management of a Morbidly Obese Patient who Underwent Tonsillectomy and Uvulopalatal Plasty after Weight Reduction Treatments Including Bariatric Surgery：A Case Report

要旨

　病的肥満も扁桃肥大も閉塞性睡眠時無呼吸（obstructive sleep apnea：OSA）症候群の原因である。病的肥満患者の気道手術は換気困難や挿管困難のリスクが高く，術後の再挿管はさらに危険が高まる。扁桃炎とOSAのために口蓋扁桃摘出術と軟口蓋形成術が予定された病的肥満患者に対して，肥満手術を先行したことで安全な気道管理を行うことができた。

　A morbidly obese patient with a high risk for difficult mask-ventilation and intubation was scheduled for tonsillectomy and uvulopalatal plasty to treat obstructive sleep apnea. Such patients are at high risk for a cannot ventilate, cannot intubate situation, particularly when postoperative surgical-site bleeding occurs. Since the tonsillectomy was not urgent, we decided to perform the surgery after reducing his body weight. The patient successfully lost considerable body weight following bariatric surgery and we performed tonsillectomy and uvulopalatal plasty uneventfully with relatively safer airway condition.