Takeshita Jun, Nishiyama Kei, Fujii Masashi, Tanaka Hiroyuki, Beppu Satoru, Sasahashi Nozomu, Shime Nobuaki
Department of Emergency and Critical Care Medicine, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa, Mukaihata-cho, Fushimi-ku, Kyoto, 612-8555, Japan.
Department of Anesthesiology, Nagahama Red Cross Hospital, Shiga, Japan.
J Anesth. 2017 Oct;31(5):779-781. doi: 10.1007/s00540-017-2373-8. Epub 2017 May 15.
The authors report a case involving an elderly patient who experienced repetitive perioperative cardiac arrest caused by laryngomalacia. The patient underwent surgery under general anesthesia; however, 2 h after initial extubation, he experienced cardiopulmonary arrest. Return of spontaneous circulation was achieved by immediate resuscitation. Four hours later, a second extubation was performed without any neurological complications. However, 2 h later, he experienced cardiopulmonary arrest again. Immediately after the third extubation, 12 h after the second cardiopulmonary arrest, fiberoptic laryngoscopy revealed laryngomalacia. His respiratory condition stabilized after emergent tracheostomy. Laryngomalacia should be considered even in adult cases when signs of upper airway obstruction manifest after extubation.
作者报告了一例涉及一名老年患者的病例，该患者因喉软化症经历了围手术期反复心脏骤停。患者在全身麻醉下接受手术；然而，初次拔管后2小时，他发生了心肺骤停。通过立即复苏实现了自主循环恢复。4小时后，进行了第二次拔管，未出现任何神经系统并发症。然而，2小时后，他再次发生心肺骤停。在第二次心肺骤停后12小时，第三次拔管后立即进行了纤维喉镜检查，发现了喉软化症。紧急气管切开术后，他的呼吸状况稳定。即使在成人病例中，当拔管后出现上呼吸道梗阻迹象时，也应考虑喉软化症。
