| Japanese |
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| Title | 硬膜外麻酔の開心術での適応 |
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| Subtitle | 特集 |
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| Authors | 西邑信男* |
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| Authors(kana) | |
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| Organization | *府中恵仁会病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 10 |
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| Number | 4 |
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| Page | 575-579 |
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| Year/Month | 1989/ |
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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 | 「特別発言」開心術の麻酔では特に循環動態におよぼす作用が問題となるその内でも冠循環への影響は無視出来ない. 従来使用されてきた吸入麻酔法にとってかわり, 最近はモルヒネおよび類似の麻酔が大量使用される傾向にある. この理由は定かではないが, おそらく吸入麻酔剤による循環動態の抑制をさけるのが, 目的であろうと推察する. したがって循環動態の抑制の少ない麻薬か麻酔剤として取り上げられているのであろう. ところがこれらの麻薬を主体とした麻酔法では, 挿管や手術操作にともなう刺激による反応を充分抑止できなく, 血圧の上昇や, 頻脈がおこりやすくなる. したがって硬膜外麻酔が取り上げられることになる. 「1. 開心術の麻酔の目的」麻酔の従来の目的は手術や麻酔の操作にともなう刺激や反射の抑制にある開心術でもっとも問題になるのは, 気管チューブ挿管や, 喉頭鏡操作にともなう刺激, 開胸(胸骨切開)にともなう刺激や, 心臓操作にともなう反射などの抑制であろう. 全身麻酔作用や筋弛緩作用は勿論のこと, これらの刺激や反射の抑制なしには適切な麻酔とはいえない. したがって麻薬を主体とする麻酔法には疑問がもたれる. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | epidural anesthesia, endotracheal intubation, blood concentration of local agents, open heart surgery |
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| English |
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| Title | Epidural anesthesia is suitable for the open heart surgery? |
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| Subtitle | |
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| Authors | Nobuo Nishimura |
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| Authors(kana) | |
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| Organization | Dept. Anesthesia Fuchu Keijinkai Hospital |
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| Journal | Circulation Control |
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| Volume | 10 |
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| Number | 4 |
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| Page | 575-579 |
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| Year/Month | 1989/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | The problem of anesthesia for open heart surgery is how to suppress cardiovascular and homonal responses to surgical stimuli and simultaenously proved a stable cardiovascular system during rapidly changing degrees of stimulation. To those aims epidural anesthesia combined with light level of general anesthesia may be suitable for open heart surgery. But many problems we must consider before to make decision. Wide spread of epidural anesthesia may be accompanied by marked degree of fall in AP, which is difficult to control. Epidural hematoma may occur during open heart surgery in which large amounts of heparin was used. Mechanism of coronary circulation become more complicated during epidural anesthesia which may produce marked coronary artery dilatation and lowering perfusion pressure. To consider the direct effect of local agents, we must measure concentration of local agents in the mixed blood instead of artery blood, which is commonly measnred. The level of epidural anesthesia should be between Th5 to Th10 and insertion catheter should be at mid thoracic, instead of cervical region. Before to reach the conclusion of epidural anesthesia will be suitable for the open heart surgy, we must performe the established method of epidural or general anesthesia and compared those method in many clinical cases about the mobility and mortality. |
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| Practice | Basic medicine |
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| Keywords | epidural anesthesia, endotracheal intubation, blood concentration of local agents, open heart surgery |
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