音響効果と超音波を用いた全身麻酔前後における気道径の比較

Changes in airway dimensions can occur during general anaesthesia and surgery for a variety of reasons. This study explored factors associated with postoperative changes in airway dimensions. Patient airway volume was measured by acoustic reflectometory and neck muscle diameter by ultrasound echography in the pre- and post-anaesthetic periods in a total of 281 patients. Neck circumference was also assessed during these periods. A significant decrease in median (IQR [range]) total airway volume (from 63.8 (51.8–75.7 [14.7–103]) ml to 45.9 (33.5–57.2 [6.4–96.3]) ml, p < 0.0001), and a significant increase in muscle diameter (from 4.3 (3.3–5.6 [2.2–9.0]) mm to 5.8 (4.7–7.3 [2.8–1.3]) mm, p < 0.0001) and neck circumference (from 34.0 (32.5–37.0 [29.5–49.0]) cm to 35.0 (33.5–38.0 [30.5–50.5]) cm, p < 0.0001) were observed. It may be possible that changes in airway volume and neck circumference were influenced by surgical duration or peri-operative fluid management (ρ) = −0.31 (95% CI −0.24 to −0.01), p = 0.0301, −0.17 (−0.23 to −0.06), p = 0.0038, 0.23 (0.12–0.34), p < 0.0001, and 0.16 (0.05–0.27), p = 0.0062, respectively). The intra-oral space can significantly decrease and neck thickness increase after general anaesthesia, and might increase the risk of difficult laryngoscopy and intubation if airway management is required after extubation following general anaesthesia.博士（医学）・甲第626号・平成27年3月16日Copyright © 1999-2015 John Wiley & Sons, Inc. All Rights Reserved.© 2014 The Association of Anaesthetists of Great Britain and Irelan

A comparison of airway dimensions, measured by acoustic reflectometry and ultrasound before and after general anaesthesia.

Changes in airway dimensions can occur during general anaesthesia and surgery for a variety of reasons. This study explored factors associated with postoperative changes in airway dimensions. Patient airway volume was measured by acoustic reflectometory and neck muscle diameter by ultrasound echography in the pre- and post-anaesthetic periods in a total of 281 patients. Neck circumference was also assessed during these periods. A significant decrease in median (IQR [range]) total airway volume (from 63.8 (51.8–75.7 [14.7–103]) ml to 45.9 (33.5–57.2 [6.4–96.3]) ml, p < 0.0001), and a significant increase in muscle diameter (from 4.3 (3.3–5.6 [2.2–9.0]) mm to 5.8 (4.7–7.3 [2.8–1.3]) mm, p < 0.0001) and neck circumference (from 34.0 (32.5–37.0 [29.5–49.0]) cm to 35.0 (33.5–38.0 [30.5–50.5]) cm, p < 0.0001) were observed. It may be possible that changes in airway volume and neck circumference were influenced by surgical duration or peri-operative fluid management (ρ) = −0.31 (95% CI −0.24 to −0.01), p = 0.0301, −0.17 (−0.23 to −0.06), p = 0.0038, 0.23 (0.12–0.34), p < 0.0001, and 0.16 (0.05–0.27), p = 0.0062, respectively). The intra-oral space can significantly decrease and neck thickness increase after general anaesthesia, and might increase the risk of difficult laryngoscopy and intubation if airway management is required after extubation following general anaesthesia.博士（医学）・甲第626号・平成27年3月16日Copyright © 1999-2015 John Wiley & Sons, Inc. All Rights Reserved.© 2014 The Association of Anaesthetists of Great Britain and Irelandidentifier:Anaesthesia Vol.69 No.12 p.1355-1363identifier:00032409identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/2938identifier:Anaesthesia, 69(12): 1355-136

Life-threatening airway obstruction due to upper airway edema and marked neck swelling after labor and delivery

Background and objectives: Airway changes generally occur in normal gravidas; however, these changes could cause critical situations in specific populations. Objectives: This article presents the case of a difficult airway patient that went into shock because of atonic bleeding after vaginal delivery for stillbirth. Case report: A 32-yr-old woman with atonic bleeding after vaginal delivery for stillbirth was transferred to our hospital. She manifested shock, and her respiratory condition was progressively deteriorating. Airway obstruction caused by neck swelling and pharyngolaryngeal edema was apparent. We tried tracheal intubation using direct and indirect laryngoscopes. However, it turned out that insertion of the laryngoscopic devices to the oral cavity was impossible. After several attempts using the Trachlight™, successful intubation was finally made. After hysterectomy, she was admitted to the intensive care unit (ICU) and treated for five days. At discharge from the ICU, her Mallampati score was I-II. Her body weight decreased 60 kg to 51 kg during ICU stay. Conclusions: We believe that concomitant attacks of labor and delivery and fluid resuscitation probably worsened upper airway and neck edema enough to cause acute airway obstruction and difficult laryngoscopy. Keywords: Labor and delivery, Difficult airway, Airway edem

Obstrução das vias aéreas com risco para a vida, causada por edema de via aérea superior e inchaço cervical significativo depois do trabalho de parto/parto

EXPERIÊNCIA E OBJETIVOS: Em geral, alterações nas vias aéreas ocorrem em grávidas normais; no entanto, essas alterações podem gerar situações críticas em populações específicas. OBJETIVOS: Esse artigo apresenta o caso de uma paciente que entrou em choque por causa de sangramento atônico em seguida a parto vaginal de natimorto. RELATO DE CASO: Mulher com 32 anos com sangramento atônico em seguida a parto vaginal de natimorto foi transferida para nosso hospital. A paciente manifestou choque e seu estado respiratório estava em progressiva deterioração. Ficou evidenciada obstrução das vias aéreas causada por inchaço cervical e edema faringolaríngeo. Tentamos intubação traqueal utilizando laringoscopia direta e indireta. No entanto, não foi possível inserir qualquer dos dispositivos de laringoscopia tentados. Depois de várias tentativas com TrachlightTM, finalmente obtivemos sucesso com a intubação. Depois da histerectomia, a paciente foi internada na unidade de terapia intensiva (UTI), onde ficou em tratamento durante cinco dias. Ao receber alta da UTI, tinha escore de Mallampati I-II. Durante sua estadia na UTI, seu peso diminuiu de 60 kg para 51 kg. CONCLUSÕES: É provável que episódios simultâneos de trabalho de parto/parto e de ressuscitação com fluidos pioraram suficientemente o edema de via aérea e o inchaço cervical a ponto de causar obstrução aguda das vias aéreas e dificuldade na laringoscopia