Tadokoro Takahiro, Yamashita Soichiro, Ishigaki Maiko, Takahashi Shinji, Tanaka Makoto
Department of Anesthesiology, Tsukuba University Hospital, Tsukuba 305-8576.
Masui. 2012 Feb;61(2):193-6.
Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. After epidural catheterization for the postoperative analgesia, general anesthesia was induced and maintained with continuous remifentanil infusion and propofol with target controlled infusion. With train-of-four ratio (TOFR) monitoring by stimulating the ulnar nerve, her trachea was intubated after 0.6mg x kg(-1) of rocuronium intravenous administration. Since then, additional rocuronium was not given for 4 hours. After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia.
僵人综合征是一种罕见疾病，其特征为躯干部和肢体肌肉僵硬及疼痛性痉挛。我们报告一例58岁患僵人综合征的女性在全身麻醉下接受胸腺切除术。术前，她每日服用25毫克地西泮、2毫克氯硝西泮和15毫克加巴喷丁。在进行硬膜外导管置入用于术后镇痛后，通过持续输注瑞芬太尼和靶控输注丙泊酚诱导并维持全身麻醉。通过刺激尺神经采用四个成串刺激比值（TOFR）监测，在静脉注射0.6毫克/千克罗库溴铵后为她进行气管插管。此后4小时未再给予额外的罗库溴铵。术后，她完全清醒，TOFR恢复至100%，但潮气量过低无法拔除气管导管，遂在重症监护病房（ICU）继续进行机械通气。次日，拔除气管导管，她从ICU出院。由于麻醉药可能会延迟僵人综合征患者呼吸功能的恢复，在全身麻醉苏醒时需要仔细评估呼吸功能。
