Nakazawa Koichi, Ikeda Daisuke, Ishikawa Seiji, Makita Koshi
Department of Anaesthesiology & Critical Care Medicine, Tokyo Medical & Dental University School of Medicine, Tokyo, Japan.
Anesth Analg. 2003 Sep;97(3):704-705. doi: 10.1213/01.ANE.0000074347.64382.A4.
In this report, we describe airway management of symptomatic lingual tonsillar hypertrophy in a pediatric patient with Down's syndrome. Besides obstructive sleep apnea, the history included a small atrial septal defect with mild aortic regurgitation and Moyamoya disease. Anesthesia was induced with IV administration of 1 mg/kg of propofol, followed by inhalation of sevoflurane in 100% oxygen. Muscle relaxants were not used on induction. Rigid laryngoscopy could not visualize the epiglottis because of hypertrophied tonsillar tissue, and mask ventilation became difficult when spontaneous breathing stopped. We avoided using a laryngeal mask airway because of a slight bleeding tendency presumably caused by preoperative antiplatelet therapy. Fiberoptic bronchoscopy through the nasal cavity in combination with jet ventilation successfully identified the glottis and allowed nasotracheal intubation to be accomplished. After lingual tonsillectomy, the patient was extubated on the seventh postoperative day, after supraglottic edema had resolved. Fiberoptic nasotracheal intubation under inhaled anesthesia may therefore be preferable in pediatric or uncooperative patients with symptomatic lingual tonsillar hypertrophy.
在本报告中，我们描述了一名患有唐氏综合征的儿科患者有症状的舌扁桃体肥大的气道管理情况。除阻塞性睡眠呼吸暂停外，病史还包括小型房间隔缺损伴轻度主动脉瓣反流和烟雾病。静脉注射1mg/kg丙泊酚诱导麻醉，随后吸入100%氧气中的七氟醚。诱导时未使用肌肉松弛剂。由于扁桃体组织肥大，硬质喉镜无法看到会厌，自主呼吸停止时面罩通气变得困难。由于术前抗血小板治疗可能导致轻微出血倾向，我们避免使用喉罩气道。通过鼻腔的纤维支气管镜联合喷射通气成功识别了声门并完成了经鼻气管插管。舌扁桃体切除术后，声门上水肿消退后，患者于术后第7天拔管。因此，对于有症状的舌扁桃体肥大的儿科或不合作患者，吸入麻醉下的纤维支气管镜经鼻气管插管可能更可取。
