重症呼吸不全を伴う高度側彎症患者の経尿道的手術に，超音波ガイド下脊髄くも膜下麻酔が有用であった1症例

Successful Application of Ultrasound-guided Spinal Anesthesia for Transurethral Surgery in a Patient with Severe Scoliosis and Respiratory Failure

要旨

　呼吸不全を合併した高度側彎症患者に対し，超音波ガイド下に脊髄くも膜下麻酔を施行し安全に管理しえた。本症例はプレスキャンによってL3-4正中線を同定した後の穿刺に複数回失敗していた。脊柱管内に到達可能な経路をリアルタイムに可視化できる超音波ガイド下脊髄くも膜下穿刺は，高度側彎症患者に有用であると考えられた。

　The applicability of spinal anesthesia in patients with severe scoliosis remains a topic of debate, primarily due to the possibility of nerve injury. We describe the successful application of ultrasound-guided spinal anesthesia in the transurethral surgery of a-year-old with severe scoliosis and respiratory failure. The initial attempts to puncture at L3-4, facilitated by ultrasound pre-scanning, were unsuccessful. Ultrasound paraspinous-view scans revealed significant calcification of the posterior complex at L3-4 and L4-5, but a narrow puncturable route at L5-S1 was viable. Spinal anesthesia was then successfully performed under real-time ultrasound guidance. This patient’s case demonstrates that ultrasound-guided spinal anesthesia can be useful for patients with severe scoliosis.