多系統萎縮症患者の乳がん手術に対するレミマゾラムを用いた全身麻酔の経験

General Anesthesia using Remimazolam for a Patient with Multiple System Atrophy Undergoing Breast Cancer Surgery

要旨

　多系統萎縮症患者の全身麻酔では循環動態不安定（特に重症低血圧），麻酔導入後および覚醒時の気道閉塞，術後呼吸不全などのリスクが高い。同患者の乳がん手術を，声門上器具で気道確保し，レミマゾラム全身麻酔と局所浸潤麻酔で行い，周術期の低血圧，気道・呼吸器合併症などを生じることなく管理できた。

　Patients with multiple system atrophy（MSA）are at a high risk of marked cardiovascular instability, especially refractory hypotension, airway obstruction, and respiratory insufficiency during the perioperative period. We describe the case of a 76-year-old female with MSA-C（cerebellar subtype）who underwent breast cancer surgery；the surgery was conducted under general anesthesia with remimazolam-remifentanil-rocuronium and supraglottic apparatus（i-gel^®）coupled with local infiltration anesthesia（LIA）. Her anesthesia and perioperative course were uneventful. She had no need for vasoactive drugs or additional opioid, airway intervention, or postoperative ventilatory support. This case suggests that using remimazolam and LIA may be preferable for patients with MSA-C.