Hidano Gumi, Nagata Osamu, Narushima Mitsuhiro, Ozaki Makoto
Department of Anesthesiology, Tokyo Women's Medical University, Tokyo 162-8666.
Masui. 2004 Jan;53(1):75-8.
A 62-year-old woman (148 cm, 48.5 kg) with a history of bronchial asthma underwent an emergency appendectomy. Ten days before the operation she developed symptoms of wheezing while under asthma medication. An endotracheal tube (7 mm) was inserted after the induction of general anesthesia with intravenous injection of fentanyl 100 micrograms, propofol 100 mg and vecuronium 10 mg under Sellick's maneuver. Anesthesia was maintained with 1% sevoflurane with oxygen 6l-min-1 just after intubation, but bilateral lung sound soon became weaker and ventilation difficult. Based on a diagnosis of bronchoconstriction, we started hyperventilation with 3% sevoflurane. Ventilation returned to normal after about 5 minutes. Percutaneous O2 saturation was maintained at 100% during this episode, but the BIS transiently rose to 82. Anesthesia was maintained with 2% sevoflurane and 50% nitrous oxide balanced with oxygen, and 250 mg aminophylline was administered. Upon completion of the operation, the endotracheal tube was removed without any events. The patient gave no sign of awareness during the operation. When severe bronchoconstriction prevents the absorption of anesthetics from the lung alveoli, additional intravenous anesthetics should be administered to maintain stable amnesia.
一名62岁女性（身高148厘米，体重48.5千克），有支气管哮喘病史，接受了急诊阑尾切除术。手术前10天，她在使用哮喘药物治疗期间出现喘息症状。在Sellick手法操作下，静脉注射芬太尼100微克、丙泊酚100毫克和维库溴铵10毫克诱导全身麻醉后插入气管导管（7毫米）。插管后立即用1%七氟醚和6升/分钟的氧气维持麻醉，但双侧肺部呼吸音很快变弱且通气困难。基于支气管痉挛的诊断，我们开始用3%七氟醚进行过度通气。约5分钟后通气恢复正常。在此期间，经皮氧饱和度维持在100%，但脑电双频指数（BIS）短暂升至82。用2%七氟醚和50%氧化亚氮与氧气平衡维持麻醉，并给予250毫克氨茶碱。手术结束时，气管导管顺利拔除。手术过程中患者未出现苏醒迹象。当严重支气管痉挛妨碍肺泡对麻醉药的吸收时，应额外给予静脉麻醉药以维持稳定的遗忘效果。
