全身麻酔導入直前に判明したメトヘモグロビン血症患者の周術期管理

Perioperative Management of Patients with Methemoglobinemia Detected Before the Induction of General Anesthesia：A Case Report

要旨

　全身麻酔導入直前にパルスオキシメータで測定した酸素飽和度低下を契機にメトヘモグロビン血症が判明した患者に対して，周術期管理法を再考しメトヘモグロビン測定を含む呼吸モニタリングを行うことにより，安全に手術を完遂することができた。メトヘモグロビン血症患者は，適切な麻酔方法とモニタリングを行うことで安全な周術期管理が可能となる。

　We report our perioperative management of a patient diagnosed with methemoglobinemia before the induction of general anesthesia.

　In methemoglobinemia, it is difficult to accurately and continuously evaluate oxygenation and methemoglobin concentrations with common monitoring devices.

　Therefore, in this case, we selected combined spinal and epidural anesthesia to avoid mechanical ventilation, and used a Radical-7 monitor, which can measure methemoglobin concentration and respiratory rate, which are important data in maintaining the patient’s oxygen balance and stable respiratory status.

　In surgery for patients with methemoglobinemia, safe perioperative management can be achieved by selecting the appropriate anesthetic and monitoring methods.