[Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan's syndrome].
A 13-yr-old male with Marfan's syndrome underwent surgical correction of severe scoliosis. He had not manifested dyspnea previously in any position. Under anesthesia with thiamylal and vecuronium, his trachea was intubated with a reinforced endotracheal tube without any difficulty. Anesthesia was maintained with nitrous oxide and fentanyl, 8 micrograms.kg-1. The patient was placed in a prone position. Thirty min after the start of operation, when orthopedists compressed the thoracic vertebrae vertically, positive pressure ventilation became impossible abruptly, even with a high airway pressure. Three min later, ventilation became possible after cessation of compression and by mouth-to-tube insufflation. SpO2 monitored with a pulse oximeter recovered immediately from 61% to 99%. A capnogram showed a lengthy retardation of an inspiratory phase. Emergency fibreoptic bronchoscopy revealed that the trachea had been compressed vertically; the compression was reduced by moving the chest supporters laterally. After the apneic episode, the operation continued uneventfully, and he was discharged a month later. A severe deformity of the thorax due to severe scoliosis and weak tracheal tissue due to connective tissue defect caused partial tracheal compression before the surgery, and made his trachea susceptible to complete obstruction by vertical external compression on the thorax. Patients with Marfan's syndrome and scoliosis should have careful preoperative airway evaluation. The selection and positioning of endotracheal tubes should be done with care. During surgery, the patient's body position and the condition of the trachea should be checked frequently. Capnography and fiberoptic bronchoscopy seem to be mandatory for early detection of tracheal stenosis and prevention of tracheal obstruction.
Kai
Y
Y
Surgical Operating Center, Kyushu University Hospital, Fukuoka.
Yamaoka
A
A
Irita
K
K
Zaitsu
A
A
Takahashi
S
S
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology* / Q000517:prevention & control; D000758:Anesthesia; D001999:Bronchoscopy; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology* / Q000517:prevention & control; D007442:Intubation, Intratracheal; D008297:Male; D008382:Marfan Syndrome / Q000150:complications*; D016684:Prone Position; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D014135:Tracheal Stenosis / Q000209:etiology* / Q000517:prevention & control