| Japanese |
|---|
| Title | AICD植え込み術3症例の麻酔管理 |
|---|
| Subtitle | 症例 |
|---|
| Authors | 原澤克己*, 大塚浩司*, 真弓享久*, 柏野繁雄*, 劔物修* |
|---|
| Authors(kana) | |
|---|
| Organization | *北海道大学医学部麻酔学講座 |
|---|
| Journal | 循環制御 |
|---|
| Volume | 12 |
|---|
| Number | 3 |
|---|
| Page | 534-540 |
|---|
| Year/Month | 1991/ |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御医学会 |
|---|
| Abstract | 「要旨」AICD植え込み術を行った3症例の麻酔経験について報告する. 麻酔薬として笑気およびフェンタニールが選択され, 人工心肺, IABPおよび体外汗除細動器の準備下に全身麻酔が施行された. 除細動の閾値決定に影響をあたえる可能性のある局所麻酔薬や揮発性麻酔薬の使用は差し控えた. 通常のモニタリングに加えて全例にSwan-Ganz catheter(OPTICATH(R) 7.5Fr)を挿入し混合静脈血酸素飽和度, 及び心拍出量の監視を行った. 術前より既に心機能の低下が認められる症例では, AICD植え込みに際し除細動閾値決定のため心室細動や心室頻拍を誘発し直流通電を行う毎に心機能に悪化がみられた. また本法はあらゆる抗不整脈薬に抵抗する難治性致死性不整脈に対し適応となることから, 術後はICU, CCUにおいて心電図をはじめ連続的な監視を行うことが望ましいと考えられた. 「はじめに」あらゆる抗不整脈薬に抵抗し, いつ発生するか予測できない難治性致死性不整脈に対し, 植え込み型自動除細動器automatic implantable cardioverter defibrillator(AICD)は最後の救命手段となる. 既に米国では1980年以来, 8,000例以上の植え込み術が行われ, AICD植え込み術後1年間での心臓突然死の割合は約2%と報告されている1). |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | AICD, fentanyl/N2O anesthesia, defibrillation threshold, SvO2 |
|---|
| English |
|---|
| Title | Anesthetic Management for AICD implantation -A report of 3 cases- |
|---|
| Subtitle | |
|---|
| Authors | Katsumi Harasawa, Kouji Otsuka, Takahisa Mayumi, Shigeo Kaseno, Osamu Kemmotsu |
|---|
| Authors(kana) | |
|---|
| Organization | Department of Anesthesiology School of Medicine Hokkaido University |
|---|
| Journal | Circulation Control |
|---|
| Volume | 12 |
|---|
| Number | 3 |
|---|
| Page | 534-540 |
|---|
| Year/Month | 1991/ |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | We reported 3 cases of anesthetic management in AICD implantation. Nitrous oxide with fentanyl anesthesia was chosen, because local or volatile anesthetics may affect the induction of arrhythmias and defibrillation threshold during the implantation procedures. An external defibrillator, IABP and cardiopulmonary bypass were ready for emergent use. Not only common monitoring devices, but Swan-Ganz catheter (Opticath(R) 7.5 Fr) were used to measure cardiac outputs and SvO2. Both cardiac output and SvO2 decreased in each series of dysrhythmia induction and DC shock. It seemed that patients whose cardiac function had already declined were candidates for the sophisticated hemodynamic monitoring. Continuous monitoring would be, necessary in ICU or CCU, since intractable and life threatning arrhythmias would occur in the AICD-implanted patients during postoperative period. |
|---|
| Practice | Basic medicine |
|---|
| Keywords | AICD, fentanyl/N2O anesthesia, defibrillation threshold, SvO2 |
|---|