[P81-1] 筋萎縮性側索硬化症患者の気管切開術の麻酔経験
A 64-year-old male patient with amyotrophic lateral sclerosis (ALS) underwent tracheotomy. General anesthesia using sevoflurane, remifentanil, propofol, rocuronium and sugammadex was performed. Anesthetic induction was done under neuromuscular monitoring using TOF-WatchTM. The use of total 0.6 mg･kg－1 of rocuronium was effective. However, neuromuscular monitoring was not useful, showing contraction of vocal cords or aryepiglottic fold at tracheal intubation, in spite of 0 of TOF count by stimulating adductor pollicis muscle and corrugator supercilii muscle. We thought that it was because of patient’s systemic variation of muscle atrophy. So, his muscle-relaxation-state was assessed by mobility of vocal cords under laryngoscope at anesthetic induction, and it was also assessed by respiratory condition or ability to open eyes at the end of anesthesia and operation. In actually, 3 mg･kg－1 of sugammadex was administered after operation, and 10 min after that, his spontaneous breathing emerged. However, it has been regarded in the literature that muscle relaxation state is recovered within 1.5-2.0 min after administration of 2 mg･kg－1 of sugammadex under normal conditions. In conclusion, in patients with ALS, TOF monitoring findings may not consistent with clinical signs, although rocuronium was effective. And sugammadex may be also used effectively, although attention should be paid to the possibility that its onset time may be longer than usual.We report this case with some literature review.