Kurokawa S, Tobita T, Taga K, Fukuda S, Shimoji K, Watanabe T, Tsuchida M, Yamato Y
Department of Anesthesiology, School of Medicine, Niigata University, Niigata 951-8510.
Masui. 2000 Nov;49(11):1242-6.
We conducted an anesthetic management to perform tracheostomy and tracheolysis in a 33 year-old female with severe stenosis extending to the lower trachea and right main bronchus. The minimal diameter of the stenotic lesion of the trachea was 3 mm according to the preoperative examinations including tomography, CT scan and magnetic resonance imaging. Since there was a high risk of airway collapse during anesthetic induction that could have made ventilation impossible, we decided to apply VV-ECMO to support gas-exchange prior to anesthetic induction. Blood gas analysis showed good results, and sufficient oxygenation and stable circulation were achieved during surgical procedures. Total intravenous anesthesia with propofol and fentanyl could provide adequate depth of anesthesia during surgery and rapid recovery with good spontaneous respiration after the termination of the infusion. VV-ECMO was a useful method to support gas-exchange in a case not requiring circulatory assistance without uneven oxygenation sometimes observed in VA-ECMO.
我们对一名33岁女性进行了麻醉管理,该患者患有严重狭窄,病变延伸至气管下段和右主支气管,需行气管切开术和气管松解术。根据术前包括体层摄影、CT扫描和磁共振成像在内的检查,气管狭窄病变的最小直径为3毫米。由于麻醉诱导期间气道塌陷风险很高,可能导致通气无法进行,我们决定在麻醉诱导前应用静脉-静脉体外膜肺氧合(VV-ECMO)来支持气体交换。血气分析显示结果良好,手术过程中实现了充分的氧合和稳定的循环。丙泊酚和芬太尼全凭静脉麻醉在手术期间可提供足够的麻醉深度,输注结束后可快速恢复且自主呼吸良好。VV-ECMO是在不需要循环辅助的情况下支持气体交换的一种有用方法,不会出现静脉-动脉体外膜肺氧合(VA-ECMO)有时观察到的氧合不均情况。