{"created":"2023-05-25T05:25:40.026506+00:00","id":4117,"links":{},"metadata":{"_buckets":{"deposit":"40ff4563-c5f8-496f-bf68-5d1b7473ab05"},"_deposit":{"created_by":17,"id":"4117","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4117"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004117","sets":["29:31:100:104"]},"author_link":["12918","12923","12926","12928","12929","12919","12927","12924","12922","12925","12932","12920","12921","12930","12931"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Pediatric anesthesia for a one-year-old boy with a lower respiratory tract infection"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"カツドウセイ カキドウ ショウジョウ オ テイスル イッサイジ ソケイ ヘルニア ノ マスイ ケイケン"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2017-02-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"14","bibliographicPageStart":"8","bibliographicVolumeNumber":"35","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学"},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article)","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"　下気道症状を有する場合は通常、周術期呼吸器関連有害事象（Perioperative respiratory adverse events、以下PRAEs）を考慮し手術を延期する必要がある。しかし、今回、湿性咳嗽や喘鳴、呼吸音の減弱を呈する小児でも良好に麻酔管理しえた症例を経験したので報告する。\n［症例］１歳４ヵ月・男児。\n［経過］鼠径ヘルニア修復術待機中に嵌頓し、当院に救急搬送された。３日前から39℃の発熱、鼻汁、咳嗽があり薬物療法中であった。受診時は解熱していたが、胸部Ｘ線検査で左上葉の浸潤影と血液検査で炎症反応上昇を認めた。その後用手整復できたため経過観察目的に入院し、１週間後に待機手術の方針となったが、入院後も呼吸器症状は改善せず、手術延期が妥当と思われた。しかし、頻繁に腸管脱出を反復し嵌頓のリスクが大きいと判断され、予定通り手術に踏み切った。麻酔はmidazolamで導入、sevoflurane、remifentanilで維持した。分泌物の気道への流入を防ぎ、呼気終末陽圧（positive end expiratory pressure、以下PEEP）をかけるため、内径3.5 mmカフ付きチューブを使用した。気管挿管後は右上肺野の呼吸音が聴取できず、喀痰吸引とリクルートメント手技を適宜施行した。また、経過中に喘鳴があり、気道過敏性亢進による気管支痙攣の可能性を疑いhydrocortisoneを静注した。以後呼吸状態は安定、トラブルなく手術終了し、手術室で抜管、経過良好で翌日退院した。\n[考察］小児のPRAEsのリスク因子に気管挿管や低年齢があげられるが、本症例は下気道症状が遷延し咳嗽が持続→腹圧上昇→腸管脱出（嵌頓）という悪循環に陥っていると考え、気道浄化のため１歳児だがカフ付きチューブを用いて気道管理を行った。麻酔中にリクルートメント手技とPEEPにより気道の開通を目指し、十分な喀痰吸引を行ったこと、気道過敏性に対してステロイドを投与したことなどが奏効し、術後は湿性咳嗽が著減し、経過良好で翌日退院できた。\n［結語］活動性下気道症状を呈する１歳児鼠径ヘルニアの麻酔を経験した。リスクに適切に対処し良好な周術期管理を行えた。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"12923","nameIdentifierScheme":"WEKO"}],"names":[{"name":"ヤリミズ, ケンヤ"}]},{"nameIdentifiers":[{"nameIdentifier":"12924","nameIdentifierScheme":"WEKO"}],"names":[{"name":"カワマエ, カネユキ"}]},{"nameIdentifiers":[{"nameIdentifier":"12925","nameIdentifierScheme":"WEKO"}],"names":[{"name":"オカダ, マサユキ"}]},{"nameIdentifiers":[{"nameIdentifier":"12926","nameIdentifierScheme":"WEKO"}],"names":[{"name":"イイザワ, 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