| Japanese |
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| Title | 肝切除術中に心停止をきたした一例 |
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| Subtitle | 症例 |
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| Authors | 上田光男*, 山本康弘*, 柏野繁雄*, 劔物修** |
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| Authors(kana) | |
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| Organization | *国立札幌病院麻酔科, **北海道大学医学部麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 7 |
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| Number | 3 |
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| Page | 865-869 |
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| Year/Month | 1986/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 64才, 男性の肝硬変合併肝癌に対して硬膜外麻酔および全身麻酔併用下に肝切除術が予定された. 肝切除術中に900ml程の比較的急速な出血を認めた時点で, 突然, アトロピンに反応しない徐脈となり, その2〜3分後, 突然, 心停止をきたし, 1分程で蘇生できた症例を経験した. 硬膜外麻酔による心臓促進神経のブロックおよび, 肝硬変患者にみられる心血管系の反応性の低下のために, 比較的急速な出血に対して反射性の循環調節がうまく働かず, 徐脈からの心停止に至ったと推測された. はじめに 近年, 肝切除術の適応手技の進歩, 患者管理の進歩に伴い拡大されてきており, 高齢者や肝硬変を伴う例も多い. 肝切除術中には, 大量出血, 下大静圧迫などによる循環動態の変動や, 高カリウム血症などの電解質異常を生じることもあり, 心停止例も報告1）されている. 今回, 肝切除術中に, 突然, 徐脈となり心停止に至った症例を経験したので, その原因について, 若干の文献的考察を加えて報告する. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | cardiac arrest, epidural anesthesia, hepatic surgery, reflex circulatory control |
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| English |
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| Title | A case of cardiac arrest during hepatectomy |
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| Subtitle | |
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| Authors | Mitsuo Ueda*, Yasuhiro Yamamoto*, Shigeo Kaseno*, Osamu Kemmotsu** |
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| Organization | *Department of Anesthesia, National Sapporo Hospital, **Department of Anesthesiology, Hokkaido University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 7 |
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| Number | 3 |
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| Page | 865-869 |
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| Year/Month | 1986/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We experienced a case of cardiac arrest during hepatic surgery assumed to be due to inhibited reflex circulatory control. A 64 year-old male（ASA II, NYHA I） undergoing hepatic surgery was anesthetized for hepatoma by nitrous oxide／enflurane combined with epidural anesthesia. In the middle of operation, abont 4 hours after operation started, the sudden bradycardia of 50 beats／min was noted on ECC monitoring and followed by cardiac arrest in 2 to 3 min even though atropine 0.5mg was administered intravenously. The patient was successfully resuscitated with both external cardiac massage and intravenous epinephrine. We speculated that the cardiac arrest was mainly, due to the inhibition of reflex circulatory control because the cardiac accelator nerve was blocked by epidural anesthesia and because cardiovascular responsiveness to refle autonomic stimulation was generally impaired in patient with liver cirrhosis. |
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| Practice | Basic medicine |
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| Keywords | cardiac arrest, epidural anesthesia, hepatic surgery, reflex circulatory control |
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