Aoki Yuta, Shakunaga Kiyoshi, Asahi Takehisa, Sasaki Rika, Murahana Junichi, Hatakeyama Noboru, Yamazaki Mitsuaki
Department of Anesthesiology, Faculty of Medicine, University of Toyama, Toyama 930-0194.
Masui. 2008 Apr;57(4):447-9.
Stiff-person syndrome is a rare disease characterized by muscle rigidity and painful spasms in the axial and limb muscles. The authors reported here a case of an axilally lymphadenectomy in a 46-year-old woman with stiff-person syndrome. With train of four ratio (TOFR) monitoring at the ulnar nerve, general anesthesia was induced and maintained with fentanyl, vecuronium and propofol with target controlled infusion. A TOFR, BIS monitor and invasive arterial pressure monitoring were employed. During the operation, there was no muscle rigidity and spasm. Ten minutes after the operation, she was fully awake and train of four ratio recovered to 95%, and extubated uneventfully. We chose propofol, because of previous reports about prolonged hypotonicity by interaction of baclofen and isoflurane. Preoperative good symptom control, choice of total intravenous anesthesia (TIVA), and application of the electrical nerve stimulator prevented postoperative hypotonia and resulted in safe anesthetic management.
僵人综合征是一种罕见疾病，其特征为躯干和肢体肌肉僵硬及疼痛性痉挛。作者在此报告了一例46岁患僵人综合征女性患者的腋窝淋巴结切除术。在尺神经四个成串刺激比率（TOFR）监测下，采用芬太尼、维库溴铵和丙泊酚靶控输注诱导并维持全身麻醉。使用了四个成串刺激比率监测、脑电双频指数（BIS）监测和有创动脉压监测。手术过程中未出现肌肉僵硬和痉挛。术后10分钟，患者完全清醒，四个成串刺激比率恢复至95%，顺利拔除气管导管。我们选择丙泊酚是因为之前有关于巴氯芬与异氟烷相互作用导致长时间低张力的报道。术前良好的症状控制、全静脉麻醉（TIVA）的选择以及电神经刺激器的应用预防了术后低张力，实现了安全的麻醉管理。
