Niwa Yasunori, Shimada Nobuhiro, Negishi Yumiko, Kai Makiko, Inoue Soichiro, Takeuchi Mamoru
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Shimotsuke 329-0498.
Masui. 2012 Aug;61(8):837-9.
A 22-year-old man weighing 188.7kg, 170cm tall (body mass index 65.2 kg x m(-2)) with bladder and rectal disturbances due to lumbar disc hernia (L4/5 and L5/S1) was scheduled for L4-5 laminectomy under general anesthesia. Awake fiberoptic intubation was attempted to prevent airway obstruction because we predicted difficult airway. During fiberoptic tracheal intubation, we easily succeeded in the insertion of the fiberscope itself into the trachea, and we succeeded in placing the reinforced tube into the trachea. Fentanyl and sugammadex were calculated with total body weight, but, remifentanil, propofol, and rocuronium were re-calculated with ideal body weight. They were given intravenously. Anesthesia was maintained with sevoflurane (1.5 to 2.0%), the fraction of inspiratory oxygen (about 0.6), remifentanil (0.1 to 0.4 microg x kg(-1) x min(-1)), and fentanyl (100 to 150 microg) as needed. After turning to prone position, severe physiological abnormal signs were not recognized. We concluded that awake fiberoptic intubation was useful and safe; moreover, anesthetic agents were administrated appropriately for morbid obesity.
一名22岁男性，体重188.7kg，身高170cm（体重指数65.2kg/m²），因腰椎间盘突出症（L4/5和L5/S1）导致膀胱和直肠功能障碍，计划在全身麻醉下进行L4-5椎板切除术。由于预计气道困难，尝试进行清醒纤维光导插管以防止气道阻塞。在纤维光导气管插管过程中，我们轻松地将纤维镜插入气管，并成功将加强型气管导管置入气管。芬太尼和舒更葡糖按总体重计算，但瑞芬太尼、丙泊酚和罗库溴铵按理想体重重新计算。它们通过静脉给药。使用七氟醚（1.5%至2.0%）、吸入氧分数（约0.6）、瑞芬太尼（0.1至0.4μg/kg/min）和按需使用的芬太尼（100至150μg）维持麻醉。转为俯卧位后，未发现严重的生理异常体征。我们得出结论，清醒纤维光导插管是有用且安全的；此外，针对病态肥胖患者适当使用了麻醉药物。
