全身麻酔中に遅発性外傷性血気胸を発症した下顎骨骨折患者の 1 例

Late-developing traumatic pneumothorax and hemothorax can occur in patients with chest trauma. We report a case of delayed traumatic hemopneumothorax that occurred during general anesthesia in a patient with a mandibular fracture associated with chest trauma. A 51-year-old male(170 cm, 87.2 kg, BMI 30)fell and sustained multiple bilateral rib fractures as well as fractures of the sternum, clavicle, right humerus, and mandible. A preoperative chest CT revealed no obvious lung laceration or pneumothorax;however, mild bilateral hemothorax was suspected. After the induction of general anesthesia, the patient became inadequately oxygenated. Endotracheal suctioning was performed, but the patient’s SpO₂ dropped rapidly. Repeated recruitment maneuvers were performed, and the SpO₂ improved. After surgery, endotracheal suctioning caused the SpO₂ to decrease once again, and recruitment maneuvers were required more frequently. A chest CT was performed under general anesthesia to investigate the cause of the reductions in SpO₂. The results revealed bilateral hemothorax, right pneumothorax, subcutaneous emphysema in the right thoracic region, and atelectasis in the posterior dorsal region. The respiratory surgeon performed an urgent thoracic drainage of the right hemothorax. The patient was extubated three days later. In addition to factors such as obesity and a smoking habit, the patient had difficulty producing sputum preoperatively because of pain from the rib fractures, which led to the atelectasis. The repeated need for high-pressure recruitment maneuvers to maintain oxygenation may have contributed to the development of the delayed traumatic hemopneumothorax. Perioperative management of patients with chest trauma should be conducted under adequate medical care, since the delayed onset or exacerbation of traumatic hemopneumothorax is possible.