両側胸水を認めた黄色爪症候群に対する胸腔鏡下胸膜生検術の麻酔経験

Anesthetic Management of a Patient with Yellow Nail Syndrome and Bilateral Massive Pleural Effusion Undergoing Thoracoscopic Biopsy Surgery

要旨

　両側大量胸水を伴う黄色爪症候群に対する胸腔鏡下胸膜生検を硬膜外麻酔併用全身麻酔で行った。術前に術中換気側である左胸腔ドレナージを行い，術中の動脈血酸素飽和度の低下なく手術を終えた。硬膜外麻酔を併用し十分な鎮痛効果を得ることで，術後呼吸状態の悪化なく経過した。

　Yellow nail syndrome（YNS）is a rare disease characterized by yellow nails, intractable pulmonary manifestations, and lymphedema. A 67-year-old man diagnosed with YNS was scheduled to undergo thoracoscopic biopsy surgery to clarify the cause of bilateral massive pleural effusion. Preoperatively, left thoracic drainage of 1,000 ml of pleural effusion was performed to prevent severe hypoxemia during one-lung ventilation in accord with the anesthesiologist’s recommendation. The operation was performed under general anesthesia combined with thoracic epidural anesthesia, and it was conducted successfully without the patient experiencing hypoxemia during the operation. The patient’s postoperative respiratory condition was stable, and he was discharged from the hospital with no complications on the 3rd post-operative day.