呼吸不全を伴う筋強直性ジストロフィー患者の乳がん手術に対する胸部傍脊椎ブロック併用のレミマゾラムを用いた全身麻酔の経験

General Anesthesia Using Remimazolam Together with Thoracic Paravertebral Block for a Patient with Myotonic Dystrophy and Respiratory Failure Undergoing Breast Cancer Surgery

要旨

　呼吸不全を伴う筋強直性ジストロフィー1型患者の乳がん手術をレミマゾラム全身麻酔＋胸部傍脊椎ブロック（thoracic paravertebral block：tPVB）で管理した。手術直後，圧迫胸帯の影響により低酸素血症を来したが，呼吸不全の悪化はなく，覚醒遅延や術後オピオイドの必要性もなかった。レミマゾラム＋tPVBは同症患者の麻酔に良い選択となる可能性がある。

　Patients with myotonic dystrophy type 1（DM1）are very sensitive to anesthetic-sedatives, opioids, and muscle relaxants, and they are at high risk of postoperative respiratory complications. A 48-year-old female patient with DM1 receiving nocturnal noninvasive positive pressure ventilation（NPPV）due to respiratory failure underwent breast cancer surgery under general anesthesia with the use of remimazolam together with thoracic paravertebral block（tPVB）. Although she required NPPV immediately after the surgery（due mainly to a chest compression dressing）, she had no delayed awakening, postoperative delirium, opioid requirement, or worsening respiratory failure. Her case suggests that remimazolam and tPVB can be a good choice for anesthesia in patients with DM1.