Yamada K, Nakagawa I, Kubota M, Niinai H, Kamiya T
Department of Anesthesia, Chugoku Rosai General Hospital, Kure.
Masui. 1997 Jul;46(7):955-8.
A 2-year-old boy with Hunter syndrome was scheduled for adenotomy under general anesthesia. Preoperative examinations of this patient revealed that he had stridor, sleep apnea, short neck, and a hypertrophic pharyngeal structure as revealed by fiberoptic pharyngoscopy, from which we expected to encounter difficulty in mask ventilation and tracheal intubation. On standby with settings for an emergency fiberoptic laryngoscopy and an emergency tracheotomy, we first attempted slow induction technique preserving spontaneous breathing. Thereafter mask ventilation was possible and a muscle relaxant was administered. On the second trial, almost blind orotratcheal intubation was successful. Postoperatively, mechanical ventilation was performed for 12 hours, in consideration of the airway obstruction due to pharyngeal bleeding and edema. The most severe anesthetic complication in the case of Hunter syndrome is the difficulty of intubation and respiratory disorder. Preoperative evaluation of the upper airway and careful perioperative monitoring and observation of respiration are of the greatest importance.
一名患有亨特综合征的2岁男孩计划在全身麻醉下进行腺样体切除术。该患者的术前检查显示，他有喘鸣、睡眠呼吸暂停、短颈，纤维喉镜检查显示咽部结构肥厚，由此我们预计面罩通气和气管插管会遇到困难。在准备好紧急纤维喉镜检查和紧急气管切开术的设备后，我们首先尝试保留自主呼吸的慢诱导技术。此后面罩通气可行，并给予了肌肉松弛剂。在第二次尝试时，几乎是盲探经口气管插管成功。术后，考虑到咽部出血和水肿导致的气道梗阻，进行了12小时的机械通气。亨特综合征患者最严重的麻醉并发症是插管困难和呼吸紊乱。对上气道进行术前评估以及在围手术期仔细监测和观察呼吸最为重要。
