口底部悪性腫瘍の術後に急性肺血栓塞栓症を発症した 1 症例

Pulmonary thromboembolism (PTE) can be a fatal complication during the perioperative period of oral surgery. PTE includes symptoms such as chest pain, dyspnea and tachycardia. We present a case of postoperative PTE after cancer resection of the oral floor performed under general anesthesia. The patient was a 77-year-old woman who underwent cancer resection of the oral floor. She did not exhibit any subjective symptoms suggesting PTE. The patient did not receive any premedication. General anesthesia was induced with fentanyl, propofol and rocuronium after obtaining peripheral intravenous access. Anesthesia was maintained with desflurane in air and oxygen. The blood pressure was maintained at 80-130/40-70 mmHg, the heart rate was 60-87 bpm, and the Pao2 was 104-159 mmHg. The surgical procedure was completed in about 5 hours without any adverse events. On postoperative day 2, she suddenly complained of dyspnea and lost consciousness. Her SpO2 decreased to 70%, and her D-dimer level increased to 18.4μg/ml. Enhanced computed tomography revealed an embolism of the right anterior basal artery from the center to the periphery, and she was diagnosed as having PTE. Anti-coagulant therapy with heparin (400-900 U/hour)was started. The treatment was effective, and her condition improved gradually. She was discharged from hospital 34 days after the surgery. Although PTE is a rare complication, it has a high mortality rate. Consequently, the possibility of PTE after surgery must be kept in mind.