Nakamoto Hirofumi, Kayama Satoru, Harada Mae, Honjo Takahiro, Kubota Kinuko, Sawamura Shigehito
Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
JA Clin Rep. 2020 Jan 21;6(1):6. doi: 10.1186/s40981-020-0311-5.
Plastic bronchitis (PB) is a complication of Fontan surgery, results in the formation of mucus plug in the tracheobronchial tree, causing potentially fatal airway obstruction. We report critical airway emergency during general anesthesia in a child with plastic bronchitis.
A 5-year-old boy was scheduled for intrapulmonary lymphatic embolization through percutaneous catheterization under general anesthesia. He underwent Fontan surgery at the age of 2 and frequently developed respiratory failure due to plastic bronchitis. After induction of general anesthesia and tracheal intubation, mechanical ventilation became difficult even with an inspiratory pressure ≥ 50 mmHg due to airway obstruction. He expectorated a large mucus plug through the tracheal tube after administration of sugammadex, naloxone, and flumazenil, and respiratory condition was stabilized thereafter.
General anesthesia for a patient with plastic bronchitis should be planned with extracorporeal membrane oxygenation or cardiopulmonary bypass stand by.
塑料支气管炎（PB）是Fontan手术的一种并发症，会导致气管支气管树中形成黏液栓，引起潜在致命性气道阻塞。我们报告了一例患有塑料支气管炎的儿童在全身麻醉期间发生的危急气道紧急情况。
一名5岁男孩计划在全身麻醉下通过经皮导管进行肺内淋巴栓塞术。他在2岁时接受了Fontan手术，因塑料支气管炎频繁发生呼吸衰竭。全身麻醉诱导和气管插管后，由于气道阻塞，即使吸气压力≥50 mmHg，机械通气仍很困难。给予舒更葡糖钠、纳洛酮和氟马西尼后，他通过气管导管咳出一大块黏液栓，此后呼吸状况稳定。
对于患有塑料支气管炎的患者，应在有体外膜肺氧合或体外循环备用的情况下计划全身麻醉。
