全身麻酔導入後にアナフィラキシーショックを呈した肺動脈性肺高血圧症の1症例

A Case of Anaphylaxis during Anesthesia in a Patient with Severe Pulmonary Hypertension

要旨

　肺高血圧症患者は周術期合併症および死亡のリスクが高い。重度の肺動脈性肺高血圧症を合併した34歳，女性の全身麻酔中に，アナフィラキシーショックを呈した症例を経験した。換気困難，低酸素血症，血圧低下を生じたが，心拍出量は維持された。速やかに診断し加療したことで致死的な循環破綻を回避することができた。

　A woman with severe pulmonary hypertension was scheduled for intestinal malrotation surgery. Two months post epoprostenol treatment, her pulmonary arterial pressure（PAP）was 114/65 mmHg, and surgery was pursued based on improvement from Class Ⅲ to Ⅱ World Health Organization functional class. After anesthesia induction, her airway pressure increased, blood pressure（BP）decreased and PAP increased. During continuous thermodilution cardiac output remained stable. We diagnosed anaphylaxis and started adrenaline infusion. Although her BP recovered promptly, her PAP remained unchanged；hence, we decided to discontinue the surgery. We believe that preoperative optimization of the patient’s condition and early diagnosis contributed to her survival.