| Japanese |
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| Title | 冠動脈再建術に対するフェンタニール10μg/kg併用下セボフルレン麻酔の影響 -血行動態の変化と血漿カテコラミン濃度の推移について- |
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| Subtitle | 原著 |
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| Authors | 西山圭子* |
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| Authors(kana) | |
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| Organization | *東京女子医科大学麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 12 |
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| Number | 2 |
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| Page | 269-277 |
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| Year/Month | 1991/ |
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| Article | 原著 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「要旨」本研究は冠動脈再建術の麻酔において, フェンタニール10μg/kg使用下に麻酔導入前平均血圧の80%値を目標としてセボフルレン吸入を行い(セボフルレン群：n=8), 胸骨切開後までの血行動態と血漿カテコラミン濃度に与える影響を検討した. 同時に血行動態に関して, エンフルレン併用麻酔法(エンフルレン群：n=8)とフェンタニール40μg/kg麻酔法(フェンタニール群：n=8)との比較検討を行った. 胸骨切開前までの変化について, 心拍数は皮膚切開後にセボフルレン群とエンフルレン群で減少効果を認めた. 1回心拍出係数はセボフルレン群において有意に減少した(p<0.01). 左室1回心仕事係数はセボフルレン群とエンフルレン群で有意に減少した(p<0.01). 全末梢血管抵抗に対する効果はセボフルレン群(p<0.01)とフェンタニール群(p<0.05)で増加傾向を示した. 胸骨切開後の変動は, セボフルレン群に比べてエンフルレン群で大きく, フェンタニール群では末梢血管抵抗の増加による平均血圧の上昇を認めた. 血漿カテコラミン濃度は胸骨切開後にノルエピネフリンの有意な増加(p<0.05)を認めた. 以上の結果より, セボフルレン併用麻酔法は, その迅速な調節性を利点としてrate pressure productや心仕事量の増加を抑制し, 末梢血管拡張作用は弱く, 冠動脈再建術の麻酔管理に対して安全に使用できると思われる. しかし, 心機能の著しく低下した症例や胸骨切開刺激においては, フェンタニールの使用量や追加投与の時期及びセボフルレンの吸入濃度への配慮が必要である. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Sevoflurane, Coronary artery Surgery, Hemodynamics, Plasma catecholamine concentration |
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| English |
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| Title | Effects of Fentanyl (10 μg/kg)-Sevoflurane anesthesia in Patients undergoing Coronary Artery Surgery -changes in hemodynamics and plasma catecholamine concentration- |
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| Subtitle | |
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| Authors | Keiko Nishiyama |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology Tokyo Women's Medical Collage |
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| Journal | Circulation Control |
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| Volume | 12 |
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| Number | 2 |
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| Page | 269-277 |
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| Year/Month | 1991/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Studies of hemodynamics and plasma catecholamine concentration in eight patients undergoing coronary artery bypass grafting were evaluated. Anesthesia were supplemented of sevoflurane-oxgen after intravenous administration of fentanyly (10 μg/kg) (sevoflurane group). Sevoflurane was administered to maintain at the 80% level of the mean blood pressure value prior to induction. An variables were measured after induction, intubation, skin incision and sternotomy. Simultaneously, hemodynamic responses were compaired with patients maintained with enflurane (enflurane group, n=8) and fentanyl (40 μg/kg) (fentanyl group, n=8). The patients of enflurane group were induced and maintained similarly to the sevofiurane group. In regard to hemodynamic changes before sternotomy, heart rate decreased after skin incision in both the sevoflurane group and the enfiurane group. Stroke volume index decreased significantly (p<0.01) in the sevofurane group. The left ventricular stroke work index decreased sighificantly (p<0.01) in both the sevoflurane group and the enflurane group. Effects on total peripheral vascular resistance showed a tendency to increase in both the sevoflurane group and the fentanyl group. Hemodynamic changes following sternotomy were larger in the enflurane group than in the sevoflurane group. A rise in mean blood pressure due to an increase in total peripheral vascular resistance was observed in the fentanyl group. In regard to plasma catecholamines, norepinephrine concentration increased significantly (p<0.05) after sternotomy. These results indicate that fentanyl (10 μg/kg) -sevoflurane anesthesia may blunt the increase in the rate pressure product and cardiac work due to its rapid control effect, and that it can be safely used in patients undergoing coronary artery surgery. However, the initial or additional dose of fentanyl and sevoflurane concentration should be carefully titrated prior to sternotomy and in patients with poor left ventricular function. |
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| Practice | Basic medicine |
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| Keywords | Sevoflurane, Coronary artery Surgery, Hemodynamics, Plasma catecholamine concentration |
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