Kojima Yuki, Furuse Kiichi, Murouchi Takeshi, Hirabayashi Kazuya, Kato Motoi, Oka Tatsuhiro
Department of Anesthesiology, Asahi General Hospital, Chiba, Japan.
Department of Plastic Surgery, Asahi General Hospital, Chiba, Japan.
Anesth Prog. 2020 Sep 1;67(3):164-169. doi: 10.2344/anpr-67-02-04.
Head and neck reconstructive surgery involving tissue flaps is often complex requiring the development of an individualized anesthetic plan. The following case report describes the anesthetic management of an 87-year-old man considered at high risk for postoperative delirium due to advanced age and blindness undergoing general anesthesia for resection of squamous cell carcinoma of the right side of the nose and reconstructive surgery with a scalping forehead flap. Ultrasound-guided local anesthetic maxillary and supraorbital nerve blocks were successfully used perioperatively to reduce the need for alternative analgesics associated with higher risks of complications such as postoperative nausea, vomiting, and delirium.
涉及组织瓣的头颈部重建手术通常很复杂，需要制定个性化的麻醉方案。以下病例报告描述了一名87岁男性的麻醉管理情况，该患者因高龄和失明被认为术后谵妄风险高，接受了全身麻醉以切除右侧鼻腔鳞状细胞癌，并采用头皮前额瓣进行重建手术。围手术期成功使用了超声引导下的局部麻醉上颌神经和眶上神经阻滞，以减少对与术后恶心、呕吐和谵妄等高并发症风险相关的替代镇痛药的需求。
