超肥満患者のくも膜下出血の周術期管理

概要

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We report the treatment of a subarachnoid hemorrhage (SAH) case of morbid obesity. A 31-year-old man (height 165 cm, body weight 240 kg, body mass index 88 kg/m2) presented with a severe headache and was referred to our hospital. Due to the difficulty of manual ventilation and swelling of the throat, an awake intubation was performed with the aid of the airway scope. Anesthesia was maintained with Propofol and Remifentanil and Rocuronium with two-phase positive endexpiratory pressure (PEEP). Although the maximum respiratory pressure was increased to 40 cmH2O with a PEEP of 10-cmH2O, tidal volume was up to 300–400 ml and a SaO2 was as poor as around 90%. Because of increased intracranial pressure (ICP) with SAH and high endtidal pressure, the operative field was narrow even though the Lieliquist's membrane was opened and the cerebrospinal fluid (CSF) was suctioned. For obese patients, special attention must be paid to perioperative management and prevention of deep venous and pulmonary thromboembolisms, as well as respiratory and circulatory ploblems. In addition, care must be taken concerning the capability of withstanding loads of fixtures from a risk management point of view.
一般社団法人日本脳卒中の外科学会の論文