グルタル酸血症2型合併小児患者における腹腔鏡下噴門形成・胃瘻造設術の麻酔管理

Anesthetic Management for Laparoscopic Cardioplasty and Gastrostomy in Pediatric Patients with Glutaric Acidemia Type 2

要旨

　グルタル酸血症2型患児の腹腔鏡下噴門形成・胃瘻造設術に対する全身麻酔管理を行った。術中は頻回の血糖値測定のもと，50％ブドウ糖溶液持続投与の調整によって血糖値を厳格にコントロールした。グルタル酸血症2型の周術期管理では，低血糖による異化亢進を予防するために血糖値の厳格な監視ならびに調整が重要である。

　A 21-month-old child with glutaric acidemia type 2 underwent laparoscopic cardioplasty and gastrostomy under general anesthesia for management of gastroesophageal reflux disease. Anesthesia was induced using fentanyl, thiopental, and rocuronium, and was maintained with administration of remifentanil, sevoflurane, and rocuronium. Based on the patient’s intraoperative blood glucose levels, we closely monitored and adjusted continuous administration of 50％ glucose solution to prevent intraoperative hypoglycemia. Strict control of blood glucose levels is crucial to prevent hypercatabolism secondary to perioperative hypoglycemia in patients with glutaric acidemia type 2.