title: [Anesthetic management of posterior lumbar spinal fusion in a patient suspected of having acute exacerbation of chronic interstitial pneumonia].
abstract: A patient complicated with interstitial pneumonia required emergency posterior lumbar spinal fusion. The blood gas analysis showed relatively benign values (PaO2 81 torr, PaCO2 44 torr, under room air), but the honeycombing lungs were noted in the bilateral lung fields on CT, and the KL-6 level was high (1,000 U x ml(-1)), for which the acute exacerbation of interstitial pneumonia was suspected. Sivelestat sodium administration was initiated during the surgery and continued postoperatively. During surgery, setting the FIO2 at 0.34, the P/F ratio and intra-airway pressure could be maintained at 500 and 25 mmHg, respectively. To reduce postoperative respiratory complication, anesthesia was maintained with desflurane, which is dissipated easily, and 0.5% ropivacaine 15 ml was subcutaneously injected to the surgical field at the time of wound closure to reduce the total doses of intraoperative fentanyl and postoperative analgesics. After the completion of surgery, the endotracheal tube was removed with head elevated position, and the patient was transported back to the ward. No acute exacerbation occurred thereafter, and the patient was discharged 67 days after surgery. The prediction of acute exacerbation of interstitial pneumonia is difficult. Moreover, there is no established preventive method, although the mortality is high. Therefore, physicians should be thoroughly informed about the currently available evidence, including developmental factors.
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Mayuko
authors.initials: M
authors.lastname: Sakai
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Tamie
authors.initials: T
authors.lastname: Takenami
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Otsuka
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Norito
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Yoshino
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 252-0374.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Okamoto
mesh_terms: D000210:Acute-Phase Reaction; D000368:Aged; D058109:Airway Management; D000758:Anesthesia; D002908:Chronic Disease; D018450:Disease Progression; D004632:Emergency Medical Services; D005260:Female; D005998:Glycine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D017563:Lung Diseases, Interstitial / Q000150:complications*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D012120:Respiration Disorders / Q000517:prevention & control; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D013449:Sulfonamides / Q000008:administration & dosage
chemical_list: D013449:Sulfonamides; C069195:sivelestat; D005998:Glycine