マスクフィットできない小児の歯ブラシ外傷に対し鎮静下経鼻ファイバー挿管を施行した1症例

A Case of Nasal Fiber Intubation Under Sedation for Toothbrush Trauma in a Child Unable to Mask Fit

要旨

　転倒により歯ブラシ先端が翼突筋静脈叢付近まで穿通した7歳女児の麻酔管理を経験した。翼突筋静脈叢からの出血リスクのため，歯ブラシをテープで口角に固定した状態で麻酔導入した。ミダゾラムとプロポフォールを静脈内投与したあと，セボフルランと酸素を吹き流し，自発呼吸を残した状態で鎮静下経鼻的にファイバー挿管した。

　A 7-year-old child fell while playing with a toothbrush in her mouth. The toothbrush penetrated the oral mucosa and reached the lateral pterygoid muscle. General anesthesia was planned for the foreign body’s removal, but there was a risk of damaging the pterygoid venous plexus if the toothbrush moved, and fitting a mask was not possible because of the toothbrush. Nasal fiber intubation was performed while preserving spontaneous breathing under sedation. Even in this case in which mask-fitting was not possible, we were able to intubate a pediatric patient under spontaneous breathing while maintaining a depth of sedation that prevented patient movement.