先天性気管狭窄症術後の高度気管再狭窄に対しECMOを回避し術中の換気を維持しえた1症例

Successful Airway Management and Ventilation during Tracheoplasty for a Patient with Recurrent Severe Congenital Tracheal Stenosis：A Case Report

要旨

　先天性気管狭窄症に対する気管形成術後に高度再狭窄を来し，再手術となった症例の麻酔を経験した。声門下より約2.5cm遠位から気管分岐部の約2cm口側に及ぶ最小径2.3mmの狭窄を来し，術前に重度の陥没呼吸も認めた。完全な換気困難に備え麻酔導入前の体外式膜型人工肺（extracorporeal membrane oxygenation：ECMO）の導入も考慮されたが，自発呼吸温存下に鎮静し，カフあり気管チューブを狭窄部より近位に留置することで換気を維持することが可能であった。

　We report a 1-year-old male infant（73 cm, 8.2 kg）who underwent emergency reoperation of tracheoplasty for a recurrence of severe congenital tracheal stenosis. To prevent critical ventilation failure and avoid the use of extracorporeal membrane oxygenation（ECMO）, anesthesia was induced with gradual dose of fentanyl and midazolam while maintaining spontaneous breathing. A cuffed tracheal tube was placed just proximal to the stenosis site, and then neuromuscular blockade was administered and high airway pressure was applied to ventilate the lung through the stenosis site. Patient’s airway and ventilation were successfully maintained until tracheostomy was performed distal to the stenosis.