Tashiro Masafumi, Shimoda Osamu, Terasaki Hidenori
Department of Anesthesiology, Kumamoto University School of Medicine, Kumamoto 860-8556.
Masui. 2002 Jul;51(7):769-71.
A 76-year-old male patient with laryngeal tumor was scheduled for elective laryngo-microsurgery. He had no dyspnea nor symptoms of obstructive lung disease detected by spirometry. Preoperative finding by laryngoscopy showed decreased movement of the left vocal cord. However, no significant narrowing was found in the glottis. Following anesthetic induction with fentanyl and thiamylal, the lungs could not be ventilated with anesthesia circuit even by use of oral airway device. After his resuming spontaneous breathing, assisted ventilation became possible. However, the lungs could not be ventilated again after vecuronium i.v. The vocal cords could not be visualized by direct laryngoscopy with a Macintosh blade. The trachea was intubated with a tracheal tube (I.D. 6.0 mm) by blind technique, and mechanical ventilation was established. The intraoperative laryngomicroscopy showed that the laryngeal tumor had grown rapidly occupying the glottis except posterior commissure. We should be careful of rapid preoperative growth of the laryngeal tumor.
一名76岁男性喉肿瘤患者计划接受择期喉显微手术。他没有呼吸困难，肺活量测定也未检测到阻塞性肺病症状。喉镜检查的术前结果显示左侧声带活动度降低。然而，声门未见明显狭窄。在使用芬太尼和硫喷妥钠诱导麻醉后，即使使用口咽气道装置，也无法通过麻醉回路进行肺通气。在他恢复自主呼吸后，辅助通气成为可能。然而，静脉注射维库溴铵后肺部又无法通气。使用麦金托什喉镜直接喉镜检查无法看到声带。通过盲探技术用气管导管（内径6.0 mm）进行气管插管，并建立了机械通气。术中喉显微检查显示喉肿瘤生长迅速，除后联合外占据了整个声门。我们应该警惕喉肿瘤术前的快速生长。
