サリドマイド胎芽病患者の全身麻酔経験

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  • Anesthetic Management in a Patient with Thalidomide Embryopathy

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<p>  We report our experience providing general anesthesia to a patient with thalidomide embryopathy. A 59-year-old man with thalidomide embryopathy, weighing 60 kg, was scheduled for dental treatment under general anesthesia because of trismus caused by microstomia. In thalidomide embryopathy, various congenital defects caused by thalidomide exposure are often accompanied by functional and structural orofacial impairments. Degenerative cervical vertebra changes, e.g., block vertebra or osteophytes, can also be seen in patients with this condition. For this reason, we considered the likelihood of technical difficulties with mask ventilation and tracheal intubation during general anesthesia. After readying the difficult airway cart and emergency cricothyrotomy kit and inducing anesthesia with propofol, we used a bronchoscope to perform nasotracheal intubation. Because of the patient’s restricted head tilt and laryngopharyngeal airway space stenosis caused by osteophytes in the epiglottal area, the position of the glottis was difficult to confirm. After multiple attempts to insert the bronchoscope tip, we succeeded in intubating the patient. Anesthesia was maintained using room air, oxygen, propofol, and remifentanil. Because of the likelihood of reintubation brought on by the high risk of post-procedure airway obstruction or difficulty in maintaining the airway, a tube exchanger was left in place while extubating the patient. Afterwards, the tube exchanger was removed once the patient’s respiration had stabilized. To obtain satisfactory airway management during general anesthesia in thalidomide embryopathy patients, an adequate pre-procedure assessment and preparation for the possibility of mask ventilation and intubation difficulties are essential.</p>

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