MLT（Microlaryngeal Tracheal）®気管内チューブで気道確保できた高度気道狭窄を伴う巨大縦隔甲状腺腫摘出術の麻酔経験

Anesthesia in the Resection of a Giant Mediastinal Thyroid Tumor with Severe Airway Stenosis：The Airway was Secured with an MLT Endotracheal Tube

要旨

　最狭窄部3.8mmの高度気道狭窄を伴う巨大縦隔甲状腺腫摘出術の麻酔を経験した。画像所見，臨床症状から内径4.0mm，長さ34cmのMLT^®気管内チューブを用いた意識下での気道確保を計画した。気管支鏡ガイド下に狭窄部を越えて挿入でき，筋弛緩薬投与後の陽圧換気も可能で，体外循環を使用せずに麻酔管理できた。

　We treated a 85-year-old male with a giant mediastinal thyroid tumor by performing a goiterectomy. Severe（3.8 mm）airway stenosis was observed at the narrowest point of the thyroid. Based on imaging findings and clinical symptoms, we planned conscious intubation with a microlaryngoscopy tube（MLT）endotracheal tube with a 4.0 mm inner dia.（Japan Medtronic, Tokyo）. We were able to insert the tube beyond the stenosis under bronchoscopic guidance, and positive pressure ventilation was possible after the administration of muscle relaxants. The anesthesia was effectively managed without resorting to extracorporeal circulation.