先天性無汗無痛症児に対する１０回の麻酔経験

DOI 参考文献15件 オープンアクセス

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  • Frequent Anesthetic Management for a Patient with Congenital Insensitivity to Pain with Anhidrosis.

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Congenital insensitivity to pain with anhidrosis is a rare disease. Patients are noted for insensitivity to pain, lack of sweating and mental retardation. They easily suffer from painless fractures and self-mutilation of the tongue, lips and fingertips with secondary osteomyelitis. We conducted general anesthesia for skin injuries, necrosis, fractures and osteomyelitis in the same child 10 times over a period of 8 years. The following points have already been reported: (1) adequate pre- and post-anesthetic sedation in order to prevent hyperthermia and injury; (2) tight control of fluid and body temperature because of anhidrosis; and (3) prudent administration of anticholinergics due to possible autonomic nerve dysfunction. Through these ten episodes of anesthesia in the patient, we learned that the following are important: (1) preanesthetic intravenous sedation for smooth induction of anesthesia; (2) endotracheal intubation following administration of neuromuscular blocking agents to secure airway and avoid aspiration pneumonitis; (3) adequate depth of anesthesia because of normal sensitivity except pain; and (4) prophylactic administration of antiemetics to prevent postoperative nausea and vomiting.

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