著者

坂井 洵子 大島 優 衛藤 希 山中 仁 守永 沙織 塚本 真規 佐藤 泰司 横山 武志

出版者

一般社団法人 日本歯科麻酔学会

雑誌

日本歯科麻酔学会雑誌 (ISSN:24334480)

巻号頁・発行日

vol.48, no.2, pp.69-71, 2020-04-15 (Released:2020-04-15)

参考文献数

13

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In pregnant women, non-obstetric surgery should be performed during an appropriate period to prevent congenital anomaly and to avoid miscarriage or premature labor. The second trimester of pregnancy is better for surgery because the risk of maternal, anatomical and physiological changes is lower. Neurotoxicity and the teratogenicity of anesthetic agents should be considered. In addition, blood flow to the placenta must be maintained during the surgery.  We performed anesthesia for an 18-week pregnant woman who required a radical neck dissection because of the metastasis of tongue cancer. She was 29 years old, 160 cm tall, and weighed 46.1 kg. Before the induction of anesthesia, the patient was placed in a left half-lateral position by placing towels under the right lower back to avoid supine hypotension syndrome, as the patient complained of a sense of abdomen distension while in a supine position. Her face was twisted to the right to secure a surgical field. General anesthesia was induced with intravenous propofol, atropine, fentanyl and remifentanil. Two milliliters of 4% lidocaine was sprayed on the subglottic area and the glottis for topical anesthesia. A tracheal tube (ID, 6.0 mm) was intubated orally using McGRATH. The anesthesia was maintained with the inhalation of 1.5%-1.7% sevoflurane in oxygen (Fio2, 0.4), as sevoflurane may be less neurotoxic to a fetus than isoflurane or desflurane. Ephedrine was administered intravenously to maintain blood flow to the placenta when the blood pressure decreased. The operation and anesthesia were completed uneventfully.  After the operation, the obstetrician performed an ultrasonography examination to confirm that the fetus had good fetal movement and a normal pulse.