出版者・発行元：Anesthesia progress  

DOI： 10.2344/anpr-67-02-05

Scopus

PubMed

出版者・発行元：Oral Science International  

DOI： 10.1002/osi2.1094

Scopus

出版者・発行元：(一社)日本歯科麻酔学会  

在胎週数34週、帝王切開で出生した児。当院NICUで管理されていた。出生後14日目に両側肺動脈絞扼術が施行され、術後に左室流出路狭窄が懸念されたため、単心室修復を行う方針となり、4ヵ月時にノーウッド手術が施行され、11ヵ月時にグレン術が施行された。さらに、1歳2ヵ月時に口唇形成術、1歳10ヵ月時に口蓋形成術を行った。口唇形成術時、麻酔は酸素2L/分、空気4L/分、セボフルラン1.5〜2.0%、フェンタニルクエン酸塩で維持し、局所麻酔薬は20万倍希釈アドレナリン含有0.5%リドカインを用いた。口蓋形成術に際しては、抜管後にSpO2が55%まで低下したため、純酸素でマスク換気を行い、患児の体動を抑えるためにセボフルランを吸入させた。マスク換気は可能であったが、SpO2が改善せず口腔内を確認したところ出血を認めたため、吸引後再挿管を行いICU管理とした。

出版者・発行元：一般社団法人 日本歯科麻酔学会  

<p>  In patients with single ventricle heart disease, non-cardiac surgery using the Glenn procedure can be performed to alleviate cyanosis prior to repair using the Fontan procedure. We performed general anesthesia management during lip repair and palatoplasty in a patient with left ventricular hypoplasia following a Glenn procedure.</p><p>  The patient underwent lip repair at an age of 1 year and 2 months and a palatoplasty at the age of 1 year and 10 months. During the preoperative examinations, hemorrhagic diathesis, hypoxemia, and secondary polycythemia were observed.</p><p>  General anesthesia was induced using midazolam, fentanyl, and remifentanil and was maintained using fentanyl and sevoflurane in oxygen (F<span style="font-variant: small-caps;">io</span>₂=0.47). Low blood pressure was treated with the administration of an α1 receptor stimulant or volume expansion with infusion to prevent an increase in pulmonary vascular resistance and to maintain the pulmonary blood flow. In addition, pulmonary blood flow was maintained by increased oxygen administration and mild hyperventilation, inhibiting any deterioration in oxygenation through the maintenance of blood flow. After the palatoplasty, hypoxemia and intraoral bleeding were observed, and reintubation was performed.</p><p>  Patients who are scheduled to undergo a palatoplasty have a high risk of bleeding because the wound surface remains in front of the palate. In addition, the risk of bleeding increases in patients with cyanosis because of the use of antithrombotic drugs, the increase in collateral blood flow, and the presence of secondary polycythemia.</p><p>  In conclusion, the risks of increased pulmonary vascular resistance, hypoxemia, and increased bleeding must be considered for safe anesthesia during a palatoplasty in patients with cyanotic heart disease.</p>

DOI： 10.24569/jjdsa.47.2_65

DOI： 10.1177/1179556519855387

PubMed