麻酔導入後に発覚した18トリソミー児のsuprastomal granulomaの1症例

A Case of Suprastomal Granuloma in a Trisomy 18 Infant Discovered After the Induction of Anesthesia

要旨

　心内修復術が予定された気管切開後18トリソミー児の麻酔導入時に，巨大化したsuprastomal granulomaによる声門下閉鎖が発覚した症例を報告する。短頸で気管切開に難渋した児，胃食道逆流によって慢性的に気道に炎症がある児は早期に肉芽が形成されている可能性があり，経口気管挿管への入れ替えや気管切開カニューレの離脱を計画する際は事前の声門下狭窄の評価は必須である。

　We report a case of subglottic closure due to a giant suprastomal granuloma that was discovered during the induction of anesthesia. The patient was an 11-month-old female infant with trisomy 18. She had undergone tracheostomy at 8 months of age due to aspiration pneumonia caused by gastroesophageal reflux disease and tracheomalacia. During the induction of general anesthesia for endocardial repair, subglottic obstruction due to suprastomal granuloma was incidentally discovered. In cases in which tracheostomy is difficult or in cases of concomitant gastroesophageal reflux disease, subglottic stenosis should be evaluated periodically, keeping in mind that inflammation of the airway mucosa can spill over chronically and promote intratracheal granulation.