Hashimoto Tomoki, Morita Minori, Hamaguchi Shinsuke, Kitajima Toshimitsu
Department of Anesthesiology, Dokkyo Medical University Hospital, Tochigi 321-0293.
Masui. 2009 Oct;58(10):1313-5.
A 68-year-old man was scheduled for pancreaticoduodenectomy under general anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34 years, and complicated with liver cirrhosis. Anesthesia was induced with propofol and fentanyl, and maintained with oxygen-air-sevoflurane and remifentanil. Epidural block was not used because the patient had coagulation abnormality and thrombocytopia. Rocuronium was injected intravenously for tracheal intubation, supplemented as required using an electrical nerve stimulator. The longer duration of action of rocuronium was observed in this case because the patient was complicated with CMTD and liver cirrhosis. We suggest that monitoring neuromuscular function may be necessary to detect subtle residual neuromuscular blockade when rocuronium is used in a patient with CMTD and liver dysfunction.
一名68岁男性计划在全身麻醉下进行胰十二指肠切除术。他患有夏科-马里-图思病（CMTD）34年，并伴有肝硬化。采用丙泊酚和芬太尼诱导麻醉，并用氧气-空气-七氟醚和瑞芬太尼维持麻醉。由于患者存在凝血异常和血小板减少症，未使用硬膜外阻滞。静脉注射罗库溴铵进行气管插管，并根据需要使用神经电刺激器进行补充。该病例中观察到罗库溴铵作用时间延长，因为患者合并CMTD和肝硬化。我们建议，当在患有CMTD和肝功能不全的患者中使用罗库溴铵时，监测神经肌肉功能对于检测细微的残余神经肌肉阻滞可能是必要的。
