Nasogastric tube syndrome suspected at the end of anesthesia

  • Ohshima M
  • Hori E
  • Suzuki A
 et al. 
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Abstract

The case of a patient who might have developed nasogastric tube syndrome at the end of anesthesia is presented. A 62-year-old woman was scheduled for a general anesthesia with fiberscopic oro-tracheal intubation because of a predicted difficult airway. After the smooth and gentle intubation without any trauma and injury, a nasogastric tube was inserted blindly. At the end of surgery, the anesthesiologists observed the pharyngeal tissue and found significant edema on the epiglottis and arytenoids. Extubation was cancelled and the patient was moved to an intensive care unit for respiratory management. On the next day, fiberscopic observation revealed a complete recovery and the endotracheal tube was removed without any difficulty. We strongly suspected the pharyngeal injury as acute nasogastric tube syndrome and an attention to this rare complication is required by anesthesiologists. 62歳女。5年前に右上顎歯肉腫瘍で上顎骨亜全摘術、両側頸部リンパ節郭清術を施行したが口腔内に再度腫瘍が出現して上顎歯肉部切除術を施行した。また、血友病Aの診断で経過観察中であった。麻酔導入前に乾燥濃縮ヒト血液凝固第VIII因子を投与した。気管挿管はフェンタニルの静脈内投与、リドカインの気管内投与を行いながら覚醒状態で気管挿管し、麻酔導入後に経鼻胃管を左鼻腔より盲目的に挿入した。手術終了後に気道周辺部から出血を認め、抜管前の喉頭部の気管支ファイバーで喉頭蓋側面、喉頭被裂軟骨部に著しい腫脹を認めた。被裂部の浮腫は胃管が走行していた右側にあり、喉頭蓋の浮腫も胃管に接した右側面に認め、経鼻胃管症候群を考えて胃管を抜去した。抜管を中止して気管挿管での人工呼吸管理で腫脹はほとんど改善し、換気量も十分に得られることを確認し抜管した。術後17日に創部出血に対し緊急手術を施行した。経過良好で初回手術後25日に軽快退院した。 この商品をチェックした方はこちらもチェックしています

Author-supplied keywords

  • Fiberscopic observation
  • Nasogastric tube syndrome
  • Rare complication

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Authors

  • Misako Ohshima

  • Etsuyo Hori

  • Akira Suzuki

  • Hiromi Katoh

  • Taiga Itagaki

  • Yushi Adachi

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