Ishida Yusuke, Nakazawa Koichi, Okada Toshio, Tsuzuki Yumi, Kobayashi Takayuki, Yamada Rikako, Uchino Hiroyuki
Department of Anesthesiology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
JA Clin Rep. 2021 Apr 5;7(1):30. doi: 10.1186/s40981-021-00434-y.
The number of robot-assisted surgeries being performed has increased in recent years, even in patients with risk factors, such as obesity, owing to advancements in medical technologies. We here report the anesthetic management of a morbidly obese woman who underwent robot-assisted surgery.
A 44-year-old woman (height, 165 cm; weight, 147 kg; body mass index, 54 kg/m) was scheduled to undergo robot-assisted laparoscopic hysterectomy for endometrial cancer. Preoperative weight loss and rehearsal of positioning during induction of anesthesia and surgical procedures greatly contributed to the surgical success. Monitoring of oxygen reserve index in combination with SpO was useful for appropriate airway and respiratory management. During anesthesia induction, the ramp position using a special commercially available cushion facilitated manual mask ventilation and tracheal intubation. Lung-protective ventilation using a limited tidal volume with moderate PEEP was applied during the robot-assisted surgical procedure.
We successfully managed anesthesia without any complications.
近年来，由于医疗技术的进步，即使是肥胖等存在风险因素的患者，机器人辅助手术的实施数量也有所增加。我们在此报告一例接受机器人辅助手术的病态肥胖女性的麻醉管理情况。
一名44岁女性（身高165厘米，体重147千克，体重指数54千克/平方米）计划接受机器人辅助腹腔镜子宫切除术以治疗子宫内膜癌。术前减重以及在麻醉诱导和手术过程中对体位摆放的预演对手术成功起到了很大作用。将氧储备指数与脉搏血氧饱和度（SpO）结合监测，有助于进行适当的气道和呼吸管理。在麻醉诱导期间，使用特殊的市售垫子采用斜坡位有助于面罩人工通气和气管插管。在机器人辅助手术过程中采用了小潮气量加适度呼气末正压的肺保护性通气。
我们成功实施了麻醉，未出现任何并发症。
