嚴重阻塞呼吸道氣管內神經纖維瘤的麻醉－－病例報告

Anesthetic Management of a Patient Undergoing Segmental Resection of Trachea with an Endotracheal Neurofibroma and Nearly Total Occlusion of Trachea

本病例報告一位因氣管內腫瘤導致氣管近完全阻塞的病患，進行腫瘤及部分氣管切除的麻醉過程。在完成所有的監視程序後開始謹慎進行麻醉誘導，並請心臟血管外科預先備妥ECMO備用。病患在清醒狀態下，經氣管內施用局部麻醉劑後，我們使用軟式支氣管鏡執行插管。整體麻醉及手術過程十分順利，術後恢復情形良好，並無任何併發症。氣管內腫瘤經病理檢驗為神經纖維瘤。原發於氣管內的神經纖維瘤非常罕見，由於氣管內腫瘤常會造成呼吸道的狹窄與阻塞，所以在氣道的處置上格外困難及危險；在局部麻醉下，先利用支氣管鏡執行檢查，確認阻塞的位置及程度後，再決定處置氣道的方式，如此可減低麻醉誘導的風險。必要時可在確定體外循環建立後再行麻醉及手術。

We report a case of endotracheal (ET) neurofibroma with resultant severe airway obstruction undergoing segmental resection of the trachea. After the extracorporeal membrane oxygenation system (ECMO) was set up handily for use and comprehensive monitoring system was established, ET intubation under fiberoptic bronchoscopy (FOB) was performed under mild sedation. Surgery and anesthesia proceeded uneventfully and she was discharged uneventfully. Thorough preoperative evaluation, comprehensively anesthetic planning, FOB-assisted ET intubation before induction of anesthesia were mandatory to achieve a safe and delicate anesthesia for such a patient. In critical situation, conduction of anesthesia after establishment of ECMO support would be another choice.