Kotoda Masakazu, Ishiyama Tadahiko, Okuyama Katsumi, Matsukawa Takashi
From the *Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan; †Surgical Center, University of Yamanashi Hospital, University of Yamanashi, Yamanashi, Japan; and ‡Department of Anesthesia, Shizuoka Children's Hospital, Shizuoka, Japan.
A A Case Rep. 2017 Mar 1;8(5):119-121. doi: 10.1213/XAA.0000000000000444.
Jeune syndrome is a rare autosomal-recessive skeletal disorder. Anesthetic management of these patients is often difficult because of thoracic and lung hypoplasia. A 5-month-old boy with Jeune syndrome was scheduled to undergo a tracheotomy. Despite 5-minute preoxygenation with continuous positive airway pressure, the patient's oxygen saturation rapidly dropped during the induction of anesthesia. The continuous positive airway pressure should have been titrated to effective tidal volume during preoxygenation to recruit the patient's functional residual capacity and to prevent desaturation. During tracheotomy, volume-controlled ventilation with a high respiratory rate and sufficient inspiratory time effectively improved the patient's respiratory status.
儒内综合征是一种罕见的常染色体隐性遗传性骨骼疾病。由于胸廓和肺部发育不全,这些患者的麻醉管理通常很困难。一名患有儒内综合征的5个月大男孩计划接受气管切开术。尽管在持续气道正压通气下进行了5分钟的预充氧,但患者在麻醉诱导期间血氧饱和度迅速下降。在预充氧期间,应将持续气道正压通气滴定至有效潮气量,以恢复患者的功能残气量并防止血氧饱和度下降。在气管切开术期间,采用高呼吸频率和足够吸气时间的容量控制通气有效地改善了患者的呼吸状况。