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Volume 72, Issue 12 （December 2023）

麻酔 72巻12号（2023年12月発行）

Japanese English

原著

脳神経外科手術におけるelectromyographic気管チューブ使用後の合併症について Complications after an Electromyographic Tracheal Tube Was Used for Intraoperative Vagal Nerve Monitoring 駒井英人 ¹ , 佐藤澄人 ¹ , 犬飼円 ¹ , 豊田茉梨子 ¹ , 重枝諒太 ¹ , 柴原一陽 ¹ , 秀拓一郎 ¹ , 松木崇 ² , 山下拓 ² , 岡本浩嗣 ³ , 隈部俊宏 ¹ Hideto KOMAI ¹ , Sumito SATO ¹ , Madoka INUKAI ¹ , Mariko TOYODA ¹ , Ryota SHIGEEDA ¹ , Ichiyo SHIBAHARA ¹ , Takuichiro HIDE ¹ , Takashi MATSUKI ² , Taku YAMASHITA ² , Hirotsugu OKAMOTO ³ , Toshihiro KUMABE ¹ ¹北里大学医学部脳神経外科 ²北里大学医学部耳鼻咽喉科・頭頸部外科 ³北里大学医学部麻酔科学 ¹Department of Neurosurgery, Kitasato University School of Medicine ²Department of Otorhinolaryngology-Head and Neck Surgery, Kitasato University School of Medicine ³Department of Anesthesiology, Kitasato University School of Medicine キーワード：迷走神経モニタリング , electromyographic気管チューブ , 喉頭浮腫 , 声帯麻痺 , 脳神経外科手術 Keyword: vagal nerve monitoring , electromyographic tracheal tube , laryngeal edema , vocal cord paralysis , neurosurgery pp.1098-1105

発行日 2023年12月10日 Published Date 2023/12/10

DOI https://doi.org/10.18916/masui.2023120004

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要旨

　脳幹を含む後頭蓋窩病変に対する外科手術において，electromyographic気管チューブ（EMGチューブ）を用いた術中神経モニタリングは，外科的侵襲に起因する迷走神経障害の回避に有用とされている。その有用性が強調される一方で，EMGチューブの使用自体に関連する合併症はあまり認知されていない。当科でEMGチューブを使用した65症例において，術後4症例に喉頭浮腫，7症例に声帯麻痺が認められた。EMGチューブは硬質で外径/内径比の大きい旧式のものと通常の気管チューブに近い新式のものがあり，旧式使用時に合併症が多い傾向が見られた。EMGチューブの特性を理解し，使用時のチューブ自体による合併症のリスクについて認識しておく必要がある。

　Background：Intraoperative neuromonitoring using an electromyographic tracheal（EMG）tube in neurosurgical interventions for posterior cranial fossa and brainstem lesions is considered useful for avoiding vagal nerve injuries. Although this advantage has been emphasized, the complications related to the use of an EMG tube are not widely recognized. We investigated the complications associated with EMG tube use.

　Methods：We retrospectively analyzed the data of 65 patients〔age median 52（12-81）〕with posterior cranial fossa or brainstem lesions who underwent surgical interventions that involved the use of an EMG tube between August 2007 and April 2022 at our hospital. Two types of EMG tubes are currently available and were used in this patient series. The new type, used in 19 of the patients, is similar in hardness and shape to a regular intubation tube. The older type, used in the other 46 patients, is rigid and has a large outer-to-inner diameter ratio. We compared the incidence of laryngeal edema, vocal cord paralysis, and the necessity of tracheotomy after the surgery between the patients whose surgeries involved each tube type.

　Results：Laryngeal edema was observed in three patients（6.5％）for whom the older-type EMG tube was used, and one of these patients required a tracheotomy. Vocal cord paralysis was observed in six patients（13.0％）in the older-type group and in one patient（5.3％）in the new-type group. All seven of these patients recovered from the vocal cord paralysis, at an average of 33.6（1-60）days.

　Conclusions：Although the usefulness of EMG tubes for vagal nerve monitoring has been documented, we need to recognize that the use of an EMG tube itself not infrequently causes laryngeal edema and vocal cord paralysis.