i-gelTM挿入困難なリウマチ性頸椎症長期罹患歴のある患者にAuraGainTMで気道確保した1症例

The AuraGainTM But Not the i-gelTM May Be Suitable to Secure the Airway for Advanced RA Patients with Cervical and Mandibular Ankylosis：A Case Report

要旨

　長期間の関節リウマチ（rheumatoid arthritis：RA）罹患歴のある70歳の女性に対し，右人工膝関節再置換術が予定された。頸部強直，下顎拘縮など，挿管困難を示唆する所見を認めたため，気道確保手段としてi-gel^TMを選択した。麻酔導入後に数回i-gel^TMの挿入を試み失敗したものの，AuraGain^TMは一度で挿入できた。進行RA頸椎病変患者に対する気道確保手段としてシャフトが直線的なi-gel^TMなどではなく，シャフトがあらかじめ90°に曲がっているAuraGain^TMなどのほうが適切な可能性がある。

　A 70-year-old woman with a 50-year history of rheumatoid arthritis（RA）was scheduled for revision right-knee arthroplasty. On physical examination, difficult intubation was anticipated due to ankylosis of the patient’s cervical spine and temporomandibular joint as well as her 1.8 cm mouth-opening maximum. We selected one of the commonly used second--generation supraglottic airway devices, i.e., the i-gel^TM, to secure the patient’s airway during anesthesia because this device had been reported to be useful for patients with cervical immobilization. However, several attempts to insert the i-gel after the induction of general anesthesia were unsuccessful. We then changed to the AuraGain^TM, another second-generation supraglottic airway device, which was inserted smoothly at the first attempt. This patient’s case indicates that the AuraGain is more suitable than the i-gel to secure the airway in advanced RA patients with cervical and mandibular ankylosis.