| Japanese |
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| Title | 頸部硬膜外麻酔中に冠スパズムを来たした症例 |
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| Subtitle | 症例 |
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| Authors | 水山和之*, 土肥修司**, 春國いづみ* |
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| Authors(kana) | |
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| Organization | *筑波大学臨床医学系麻酔科, **岐阜医学部麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 11 |
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| Number | 4 |
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| Page | 547-551 |
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| Year/Month | 1990/ |
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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 | 「要旨」頸部硬膜外麻酔は, 心筋の虚血の程度と範囲を減少させ, 重症不整脈の頻度を減少させる. 当科では肺及び乳房手術に対し4年間で668回の頸部硬膜外麻酔を施行したが, 今回はじめて冠動脈疾患の既往のない患者で術中に冠スパズムが発生した症例を経験した. 患者は60歳の男性で, 頸部硬膜外麻酔及び酸素6L/分とエンフルレン0.6%で維持し, 左肺上葉切除が施行されていた. 循環動態は安定しており, PaCO2 35-40mmHgに保っていたが, 肺動脈の周囲を剥離していたとき, 心室頻拍を伴った著明なST上昇が見られた. リドカイン投与などの処置で, 約20分後ST上昇は回復した. 冠スパズムの機序として副交感神経の関与が考えられ, 頸部硬膜外麻酔は心臓交感神経を遮断しているためその誘因となっている可能性がある. 「はじめに」頸部硬膜外麻酔, すなわち高位の硬膜外麻酔は, 末梢血管を拡張し心臓交感神経を抑制して心筋酸素消費量を減少させる1,2)ので, 虚血をきたした心筋の酸素需給バランスを改善する. この作用は, β遮断薬と比較し同程度以上の効果が期待できる3). また, 心筋の内層-外層血流比を改善し4), 梗塞巣を縮小させ5), 重症不整脈の頻度を減少させ6), 気道刺激に対する反応を減少させる7). |
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| Practice | 基礎医学・関連科学 |
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| Keywords | coronary artery spasm, cervical epidural anesthesia, cardiac sympathectomy |
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| English |
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| Title | Coronary Artery Spasm during Cervical Epidural Anesthesia |
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| Subtitle | |
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| Authors | Kazuyuki Mizuyama*, Shuji Dohi**, Izumi Harukuni* |
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| Authors(kana) | |
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| Organization | *Department of Anesthesiology Institute of Clinical Medicine University of Tsukuba, *Department of Anesthesiology Gifu University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 11 |
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| Number | 4 |
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| Page | 547-551 |
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| Year/Month | 1990/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Coronary artery spasm during lung surgery occurred in a noncoronary patient anesthetized with cervical epidural block and light enflurane-N2O-O2. Profound ST-segment elevation in the II lead ECG monitor developed and followed ventricular tachycardia, which associated with surgical manipulation of left pulmonary artery. This episode was not preceded by hypertension, tachycardia, hypocarbia, vagal stimulation or the manipulation of heart. It lasted for 20 min, and postoperative ECG and cardiac enzyme measurements revealed within normal limit. This is only a case of coronary artery spasm among 668 patients undergoing pulmonary or mammary surgery for which we have indicated cervical epidural anesthesia supplemented with light general anesthesia. Although several reports support that high level of epidural anesthesia has several beneficial effects on ischemic heart, the present case shows that cardiac sympathectomy by epidural anesthesia couldn't prevent the coronary spasm. The episode of coronary spasm might be associated with increased parasympathetic activities on coronary arteries because cardiac sympathetic nerve was completely blocked with cervical epidural anesthesia. We should pay attention to ST-segment change on ECG monitor even during high level epidural anesthesia. |
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| Practice | Basic medicine |
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| Keywords | coronary artery spasm, cervical epidural anesthesia, cardiac sympathectomy |
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