Kohno Yumiko, Koishi Keiko, Watanabe Kazunori, Nishiyama Tomoki
Department of Anesthesiology and Critical Care, Higashi Omiya General Hospital, Saitama 337-0051.
Masui. 2013 Mar;62(3):341-3.
An 83-year-old woman was scheduled for surgery of the left upper and lower extremity fracture. She had past history of lung partial resection for lung cancer and rheumatoid arthritis, and recent history of pneumonia. She also had fluid retention in the thoracic cavity. Open resection of the femoral neck fracture was first performed uneventfully under spinal anesthesia with bupivacaine 0.5% 2 ml. Then, interscalene blaxioplexus block was performed with 0.75% ropivacaine 15 ml and 1% lidocaine 10 ml for tension band wiring of the fractured olecranon. Midazolam 1 mg and propofol 1.5 mg x kg(-1) x hr(-1) were administered for sedation. Thirty minutes after the block, oxgen saturation decreased to 92% under O2 3 l x min(-1) by a mask. She was intubated and arterial carbon dioxide tension was above 150 mmHg. A few hours later, she became conscious and mask CPAP was used after extubation for one day. Pa(CO2) was 90-100 mmHg for 3 days and decreased to 56.9 mmHg on the 6th day, but her consciousness had been clear. Phrenic nerve palsy and sedation in the patient with decreased lung function might have induced prolonged hypercapnea.
一位83岁女性计划接受左上肢和下肢骨折手术。她既往有因肺癌行肺部分切除术及类风湿关节炎病史，近期有肺炎病史。她还存在胸腔积液。首先在0.5%布比卡因2 ml脊髓麻醉下顺利完成股骨颈骨折切开复位术。然后，采用0.75%罗哌卡因15 ml和1%利多卡因10 ml行肌间沟臂丛神经阻滞，用于骨折尺骨鹰嘴张力带钢丝固定术。给予咪达唑仑1 mg和丙泊酚1.5 mg·kg⁻¹·h⁻¹进行镇静。神经阻滞后30分钟，面罩吸氧3 l·min⁻¹时氧饱和度降至92%。她接受了气管插管，动脉血二氧化碳分压高于150 mmHg。数小时后，她恢复意识，拔管后使用面罩持续气道正压通气一天。动脉血二氧化碳分压（Pa(CO2)）持续3天维持在90 - 100 mmHg，第6天降至56.9 mmHg，但她的意识一直清醒。肺功能下降患者的膈神经麻痹和镇静可能导致了长时间的高碳酸血症。
