左肺動静脈瘻を有するオスラー・ウェーバー・ランデュ病患者の右側下葉切除術の麻酔管理

Anesthetic Management of Right Lobectomy in an Osler-Weber-Rendu Disease Patient with Left Pulmonary Arteriovenous Fistula

要旨

　左肺動静脈瘻を有するオスラー・ウェーバー・ランデュ病患者の右側下葉切除術における全身麻酔を経験した。シャント率の高い肺動静脈瘻に対し，事前に経カテーテル的コイル塞栓術を行ったことで一側肺換気でも安全な麻酔管理が行えた。

　One-lung ventilation（OLV）increases shunting, and occasionally, patients with high shunt suffer from hypoxemia that is unresponsive to oxygen administration. We report a case of right lobectomy in a 73-year-old man with Osler-Weber-Rendu disease and left pulmonary arteriovenous fistula（PAVF）. We performed coil embolization and improved the shunt rate from 23％ to 10％ before the lobectomy. During the operation, the Pao₂/Fio₂ ratio declined after the initiation of OLV. However, the ratio improved slightly following aspiration and alveolar recruitment maneuvers whereby safe anesthesia management was achieved. Improving the right-left shunt preoperatively is important in patients with PAVF.