Koishi K, Miyazaki N, Oe Y, Asari H
Second Department of Anesthesiology, University of Toho School of Medicine, Tokyo.
Masui. 1997 Jul;46(7):966-9.
A 23-year-old woman was supposed to undergo thoracoscopic surgery for the 10th pneumothorax that accompanied histiocytosis X. The past history included Lylle's disease, asthma, myocarditis, drug-induced leucocytopenia and bronchitis obliterans. The preoperative arterial blood gas analysis under receiving O2 at rate of 2 l.min-1 via a nasal cannula revealed normal values. General anesthesia and intubation with a double-lumen endotracheal tube would have been preferable, but regional anesthesia was chosen because of her medical history and positive results of the skin tests for vecuronium, pancronium, diazepam and midazolam. During the first 10 min of thoracoscopic procedure, her respiration became rapid and shallow and she was restless and comatose. The operation was cancelled. Arterial blood gas analysis under receiving O2 at rate of 4 l.min-1 via a face mask revealed: pH 7.025, PaO2 113.8 mmHg, PaO2 244.8 mmHg, HCO3- 29.7 mEq.l-1, BE-5.6, and O2 saturation 99.1%. Manual artificial ventilation with a mask and bag was initiated. Her spontaneous respiration and consciousness recovered in next 30 min. The postoperative course was uneventful. Tachypnea, caused from anxiety, dyspnea and stimulation of irritant receptors in the airway, were considered to be responsible for the event. The duration of inspiration became shorter as tachypnea developed, that made the tidal volume to decrease and hypercapnea ensued.
一名23岁女性因伴有组织细胞增多症X的第10次气胸拟行胸腔镜手术。既往史包括莱尔氏病、哮喘、心肌炎、药物性白细胞减少症和闭塞性支气管炎。术前经鼻导管以2升/分钟的速率吸氧时进行的动脉血气分析显示值正常。采用双腔气管内导管进行全身麻醉和插管本会更好，但由于她的病史以及维库溴铵、潘库溴铵、地西泮和咪达唑仑皮肤试验呈阳性结果，所以选择了区域麻醉。在胸腔镜手术的前10分钟内，她的呼吸变得急促且浅，并且烦躁不安、昏迷。手术取消。经面罩以4升/分钟的速率吸氧时进行的动脉血气分析显示：pH 7.025，动脉血氧分压（PaO2）113.8毫米汞柱，动脉血二氧化碳分压（PaCO2）244.8毫米汞柱，碳酸氢根（HCO3-）29.7毫当量/升，碱剩余（BE）-5.6，以及氧饱和度99.1%。开始用面罩和气囊进行人工手动通气。接下来的30分钟内她的自主呼吸和意识恢复。术后病程平稳。由焦虑、呼吸困难和气道刺激性感受器受刺激引起的呼吸急促被认为是该事件的原因。随着呼吸急促的发展，吸气持续时间变短，这使得潮气量减少，继而出现高碳酸血症。
