| Japanese |
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| Title | 麻酔中の冠循環管理 -心筋血流観察へのサーモグラフィの応用- |
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| Subtitle | 特集 |
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| Authors | 横田祥*, 石川岳彦*, 劔物修* |
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| Organization | *北海道大学医学部麻酔学講座 |
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| Journal | 循環制御 |
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| Volume | 13 |
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| Number | 1 |
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| Page | 33-38 |
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| Year/Month | 1992/ |
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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 | 「はじめに」麻酔中の冠循環管理は手術適応の拡大と手術患者の高齢化により益々重要性を増している. とくに虚血性心疾患を持つ患者の麻酔管理法に関してさまざまの議論が行なわれている. その第一には麻酔法の選択であり, 麻酔薬によっては冠血流現象によって, 虚血部への血流をさらに減少させるとされた1). また, 胸部硬膜外麻酔による交感神経ブロックが心筋虚血部にどの様な影響を及ぼすかも問題となっている. 第二には冠血管拡張薬の使用法とその作用機序についてであり, 亜硝酸薬の予防的持続投与が有効であるかどうかなどの問題である. 第三には手術前に使用されているカルシウム拮抗薬や, β遮断薬などを継続するかどうか, また, 麻酔中これらの薬物をどう利用するかなどの問題がある. 第四には麻酔中の虚血心のモニタとして何が必要かなどの問題である. これらの問題に的確な解答を出すためには心筋の血流を直接, 連続的に観察する事が必要であり, 著者らはこれらの問題を検討する目的で高速, 高解像度のサーモグラフィを利用した動物実験法を開発し, いくつかの知見を得ているのでここに紹介する. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Anesthesia and coronary circulation -A thermographic study- |
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| Authors | S.Yokota, T.Ishikawa, O.Kemmotsu |
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| Organization | Department of Anesthesiology Hokkaido University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 13 |
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| Number | 1 |
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| Page | 33-38 |
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| Year/Month | 1992/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We briefiy reviewed some problems on anesthesia and coronary circulation including, coronary steal induced by isoflurane, and effects of nitroglycerin on the size of ischemic area. We developed the computerized experimental system that can observe real-time changes in size of ischemic area of beating heart using a thermography. The ischemic area defined by the sy’stem is named Thermographically Determined Myocardial lschemic Area (TDMIA). This system includes monitoring and filing of heart rate, blood pressure, pulmonary artery pressure, central venous pressure, cardiac output, myocardial pH, end-tidal CO2, anesthetic gas concentrations and temperatures. We compared effects of enfiurane and isoflurane on TDMIA in both dogs and swine. When anesthetic concentrations were changed from 1 MAC to 0.5 MAC, TDMIA decreased significantly together with increases in blood pressure and cardiac output. When anesthetic concentrations were increased, TDMIA increased in both anesthetics. We found no significant differences in changes of TDMIA between enflurane and isoflurane anesthesia. We concluded that isoflurane could prodUce coronary steal theoretically, but might be as safe as other anesthetics clinically. Nitroglycerin with or without dopamine infusions were evaluated to examine if they were beneficial to the ischemic area in dogs. Nitroglycerin 0.5 mcg/kg/min alone seemed to decrease TDMIA but 1 mcg/kg/min had no effects on TDMIA compared to control dogs. Nitroglycerin 1 mcg/kg/min with dopamine 7.5 mcg/kg/min significantly decreased TDMIA. We speculated that the coronary dilating effect of nitroglycerin interacted the positive inotropic effect of dopa, mine. We concluded that nitroglycerin combined with dopamine had some beneficial effects on myocardial ischemic area in an acute phase of AMI in dogs. |
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| Practice | Basic medicine |
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