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題 名 | General Anesthetic Management for Diagnostic Splenectomy in a Patient with Paraneoplastic Pemphigus=脾臟切除術及免疫抑制療法後薰煙色麴菌感染造成的肝膿瘍 |
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作 者 | 鄭淳心; 詹光政; 蘇彰甫; 莫世湟; 林珍榮; 孫維仁; | 書刊名 | 臺灣醫學會雜誌 |
卷 期 | 102:7 2003.07[民92.07] |
頁 次 | 頁497-500 |
分類號 | 415.695 |
關鍵詞 | 脾臟切除術; 肝膿瘍; 免疫抑制療法; General anesthesia; Intratracheal intubation; B-cell lymphoma; Pemphigus; Perioperative care; |
語 文 | 英文(English) |
英文摘要 | Paraneoplastic pemphigus (PNP) is an autoantibody-mediated mucocutaneous blistering disease that often occurs with confirmed or occult malignancy. It is often accompanied by extensive eruption of respiratory mucosa and can lead to respiratory failure. The indications for anesthetic management in patients with PNP are rare due to the high risk of generating further eruption of respiratory mucosa during intubation, with potentially disastrous consequences. We report the anesthetic management in a 43-year-old woman with PNP scheduled for diagnostic splenectomy. The surgery was postponed due to persistent hoarseness, diffuse oral-pharyngeal mucositis, and laryngeal erosion. Methylprednisolone 40 mg 3 times daily was prescribed for controlling the mucosa lesion. Two weeks later, after the improvement of mucosal lesion, direct laryngoscopic intubation and the scheduled splenectomy were performed under general anesthesia. Pathology of the spleen showed low-grade B-cell lymphoma had induced PNP. Flexible fiberoptic bronchoscopic examination revealed neither bleeding nor bullae formation in the trachea either immediately after intubation or before extubation. The tracheal mucosa is highly susceptible to mechanical stimulation with direct laryngoscopic intubation. Cuff inflation and positive pressure ventilation, awareness of the disease characteristics of PNP, a sufficient course of steroid therapy beforehand, and adequate mucosal protection are essential to the uneventful anesthetic management of the patient with PNP involving the respiratory tract mucosa. |
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