重度肥胖伴阻塞性睡眠呼吸暂停综合征剖宫产麻醉1例（1 cases of severe obesity complicated with obstructive sleep apnea syndrome undergoing cesarean section）.doc

重度肥胖伴阻塞性睡眠呼吸暂停综合征剖宫产麻醉1例（1 cases of severe obesity complicated with obstructive sleep apnea syndrome undergoing cesarean section） 1 cases of severe obesity complicated with obstructive sleep apnea syndrome undergoing cesarean section Wang Xin Gao Jingui Patients, female, 36 years old, the main intrauterine pregnancy 40 weeks plus 3 days, the first fetal LOP without birth sign admission, weight 103 kg, height 158 cm, BMI41kg/m2, intends to perform cesarean section. Preoperative interview, asking about the course of medical history, the family complained of snoring when sleeping, and obstructive apnea, syndrome, sleep (OSAS) was confirmed by the consultation of doctors in Department of ENT. Before anesthesia, 30min intramuscular injection of atropine 0.5mg, into the operation room to establish venous access, after epidural puncture. Lumbar puncture point (L) 2-3 clearance, because the patient waist thick subcutaneous, intervertebral contact is not clear, 8cm epidural puncture needle in conventional applications have all entered the skin, repeated puncture needle tip but never reached the yellow ligament, epidural anesthesia failure was changed to general anesthesia. Choose sober, sedation, amnesia, fiberoptic intubation, 1% tetracaine throat mucosal surface anesthesia, thyrocricocentesis intratracheal injection of 1% dicaine 3ml 0.02mg/kg slow intravenous injection of midazolam, remifentanil intravenous infusion of 0.05ug.kg-1.min-1. The operator is located in patients with head, neck with a thin cushion pillow, the head back as far as possible, bronchofibroscope stem and tracheal tube respectively with tetracaine lubrication, the tracheal catheter is sheathed on the bronchofibroscope stem. Bronchoscopy through the mouth into the throat, visible epiglottis and glottis, ask the patient to take a deep breath in patients breathing when the bronchoscope gently into the trachea internal process about 5cm, then the endotracheal tube into the trachea, exit bronchoscopy. The