Takahashi Tamayo, Yoshida Mitsuhiro, Ito Nanako, Koizumi Koichi, Kamio Hisanobu, Oda Aya, Oue Kana, Doi Mitsuru, Shimizu Yoshitaka
Anesth Prog. 2025 Mar 12;72(1):33-36. doi: 10.2344/23-0036.
Bronchiectasis is a clinical syndrome characterized by coughing and sputum production in the presence of abnormal thickening and dilatation of the bronchial walls. We report the successful anesthetic management of a 91-year-old patient with severe bronchiectasis undergoing left marginal mandibulectomy for squamous cell carcinoma of the mandibular gingiva. In this case, we utilized respiratory prehabilitation for preoperative optimization of the patient's respiratory function and intravenous moderate sedation with dexmedetomidine and pentazocine plus excellent local anesthesia intraoperatively rather than an intubated general anesthetic. During the procedure, the patient's vital signs were stable, and she did not have any psychological or physical complaints like anxiety or pain and was discharged from the hospital without any complications. Considering the high risk of respiratory complications, intravenous moderate sedation may be a better option than general anesthesia for some surgeries in patients with severe bronchiectasis. These strategies may be useful options for older patients with impaired respiratory function undergoing oral surgery procedures.
支气管扩张症是一种临床综合征，其特征为在存在支气管壁异常增厚和扩张的情况下出现咳嗽和咳痰。我们报告了一例91岁患有严重支气管扩张症的患者，该患者因下颌牙龈鳞状细胞癌接受左下颌边缘切除术，其麻醉管理取得成功。在本病例中，我们采用呼吸预康复来术前优化患者的呼吸功能，并在术中使用右美托咪定和喷他佐辛进行静脉中度镇静以及出色的局部麻醉，而非插管全身麻醉。手术过程中，患者生命体征稳定，没有出现任何如焦虑或疼痛等心理或身体不适，且出院时无任何并发症。考虑到呼吸并发症的高风险，对于一些患有严重支气管扩张症的患者进行手术，静脉中度镇静可能是比全身麻醉更好的选择。这些策略对于呼吸功能受损的老年患者接受口腔外科手术可能是有用的选择。
