自律神経過反射と抜管後換気不全を来した慢性期脊髄損傷患者の麻酔管理：3種類の麻酔法を試みた1症例

Anesthetic Management of a Chronic Spinal Cord Injury Patient Complicated by Autonomic Dysreflexia and Post-extubation Ventilatory Failure：Three Anesthetic Techniques

要旨

　慢性期脊髄損傷患者の緊急局所麻酔下泌尿器科手術中に自律神経過反射を発症したため，脊髄くも膜下麻酔を試みたが穿刺困難であり全身麻酔に移行した。術後手術室と術翌日に集中治療室でそれぞれ再挿管を要した。脊髄損傷患者の周術期には自律神経過反射と呼吸器合併症を考慮した麻酔法の選択と綿密な抜管計画が必要である。

　Our 59-year-old male patient with a chronic spinal cord injury developed autonomic dysreflexia during emergency urological surgery under local anesthesia. Spinal anesthesia was attempted but proved difficult, necessitating conversion to general anesthesia with sevoflurane. Postoperatively, the patient required reintubation in the operating room and again the following day in the intensive care unit. The perioperative management of patients with a spinal cord injury requires a careful selection of anesthetic techniques and meticulous extubation planning, considering the risk of autonomic dysreflexia and respiratory complications.