Konda Makiko, Inoue Satoki, Naito Yusuke, Egawa Junji, Kawaguchi Masahiko
Division of Intensive Care and Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
JA Clin Rep. 2021 Jan 4;7(1):1. doi: 10.1186/s40981-020-00408-6.
We report a case of a morbidly obese patient who developed life-threatening airway obstruction due to angioedema.
A 50-year-old Japanese morbidly obese female was treated with enalapril for 10 years, with no history of angioedema. After 3 h of completion of breast cancer resection under general anesthesia with tracheal intubation, she developed airway obstruction and respiratory arrest. Her oral cavity was occupied with a swollen tongue. It was extremely difficult to determine the airway anatomical orientation although tracheal intubation was attempted using a videolaryngoscope. At this time, she probably started gasping respiration, which generated a faint bubble and revealed a possible airway. Her airway was established using a tracheal tube without confirming the glottis or the vocal cord.
Angioedema induced by angiotensin-converting enzyme (ACE) inhibitors is rare; however, once it occurs, it can be potentially life threatening, especially for patients with possible difficult airway. Considering the risk-benefit ratio, we must be careful in administering ACE inhibitor therapy in morbidly obese patients.
我们报告一例病态肥胖患者因血管性水肿导致危及生命的气道梗阻。
一名50岁的日本病态肥胖女性接受依那普利治疗10年，无血管性水肿病史。在全身麻醉下行气管插管的乳腺癌切除术后3小时，她出现气道梗阻和呼吸骤停。她的口腔被肿胀的舌头占据。尽管尝试使用视频喉镜进行气管插管，但极难确定气道的解剖方位。此时，她可能开始出现喘息样呼吸，产生了微弱的气泡，显示出可能的气道。在未确认声门或声带的情况下，使用气管导管建立了她的气道。
血管紧张素转换酶（ACE）抑制剂诱发的血管性水肿罕见；然而，一旦发生，可能会危及生命，尤其是对于可能存在困难气道的患者。考虑到风险效益比，在病态肥胖患者中使用ACE抑制剂治疗时我们必须谨慎。
