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September 08, 2006

麻酔科医に禁固2年求刑

------------------------引用開始------------------------

金沢市の医療福祉施設で行われた男児=当時(4)=の足首の手術で、麻酔から覚める際に適切な処置をせず男児を死亡させたとして、業務上過失致死罪に問われた金沢大名誉教授の麻酔医村上誠一(むらかみ・せいいち )被告(80)の論告求刑公判が28日、金沢地裁(堀内満(ほりうち・みつる)裁判長)であり、検察側は禁固2年を求刑した。

検察側は論告で「気道確保のためのチューブを気管内に挿管したことを確認すべきなのに、食道へ挿管して長時間放置した初歩的な過失」と指摘した。村上被告は無罪を主張している。

論告によると、村上被告は2001年2月、石川整肢学園で麻酔医として男児の手術を担当。男児が麻酔から覚める際、気道確保を適切に行わなかったため、男児を急性呼吸障害で死亡させた。

遺族が同学園と村上被告に損害賠償を求めた民事訴訟は、昨年末に和解している。

(共同通信社、2006年8月29日)

------------------------引用終了------------------------

まずは男児のご冥福を祈るとともに,遺族には心よりお悔やみ申し上げる。


どのような経緯があったのか,上の記事では詳細はわからない。

食道挿管のまま手術を完遂できるとは思えないので,手術中は正しく気管挿管されていたと推測される。

手術が終了して抜管したが,呼吸状態が悪くなり再挿管しようとして失敗したのか?
聴診や胸郭の動き(視診)ではわかりにくかったのか?
カプノメーターは最初からなかった,あるいは外した後に再挿管したのか?
再挿管後にパルスオキシメーターの数値は改善したのか? それともこれも外していたのか?

>食道へ挿管して長時間放置した初歩的な過失

この長時間がどれほどの時間なのかわからないが,食道挿管で自発呼吸がなければものの数分あるいは数十秒で心停止に至るだろう。自発呼吸が残っており,気道も閉塞していなかったのではないか。
人工呼吸器にしろTピースにしろ,食道挿管で酸素は胃に送られるものの,自発呼吸があれば肺にはルームエアーが届く。この自発呼吸のおかげでSPO2の急激な低下は免れたのかもしれない。

自発呼吸がない患児に食道挿管したなら,すぐに状態が悪化するので挿管失敗に気づくだろうし,マスク換気や挿管のやり直しなどの対応をただちにとれただろう。

報告者の氏名がそのまま疾患名になったような症候群では小顎症などを伴うことが多い。男児がこのような症候群だったかどうかは不明だが,挿管困難症だった可能性はある。手術前の最初の挿管では筋弛緩が効いていて口も良く開き体動もないため何とか挿管できたが,抜管後の再挿管では体動や分泌物で条件は悪くなったということは充分考えられる。成人の挿管困難に対しては多くのストラテジーがあるが,小児にも使えるものは少ない。挿管が難しいならばラリマという手もあるが,元麻酔科教授とはいえ当時75歳の先生が小児にラリマを使用した経験があるかどうかも怪しい。

また,麻酔科の名誉教授が「よし,挿管できた」と言っているのに,「食道挿管ではないですか」と言える整形外科医や看護師はまずいない。

表MLを見て書いたわけではない。下書きしたのは昨日だ。


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