Japanese
Title経皮冠動脈拡張術後の緊急冠動脈バイパス術の麻酔管理
Subtitle症例
Authors菊地信明*, 小村好弘*, 真弓享久*, 劔物修*, 川埜芳照**, 脇坂博士**, 杉木健司***, 大野猛三***
Authors(kana)
Organization*北海道大学医学部麻酔学講座, **北海道大野病院麻酔科, ***北海道大野病院心臓血管外科
Journal循環制御
Volume14
Number1
Page71-75
Year/Month1993/
Article報告
Publisher日本循環制御医学会
Abstract「はじめに」経皮冠動脈拡張術(PTCA： percutaneous transluminal coronary angiolpasty)は現在, 冠動脈バイパス術(CABG)とならぶ虚血性心疾患に対する血行再建法の主流である. 手技の向上やカテーテルシステムの改良により, その成功率は, 90％を越え, 良好な生存率を記録している1). しかし, 本法には重篤な合併症として急性冠閉塞があり, その際には緊急冠動脈バイパス術による対処が必要となることが多い. このような患者は, リスクが高く, 麻酔管理上も様々な問題を持っている. 最近, 私どもは, 10例のPTCA後の緊急冠動脈バイパス術症例を経験し, 全例生存という良好な結果を得ている. 代表的な1症例を呈示し, PTCA後の緊急冠動脈バイパス術の麻酔管理について考察を加える. 「症例」10例の年令, 性, 病変部位, IABP使用の有無, PTCAによる急性冠動脈閉塞から麻酔開始までの時間(TI), 麻酔時間(TA), 人工心肺時間(TCPB)を表1に示す.
Practice基礎医学・関連科学
Keywords
English
TitleAnesthetic management of emergency coronary artery bypass graft surgery following percutaneous transluminal coronary angioplasty
Subtitle
AuthorsNobuaki Kikuchi*, Yoshihiko Komura*, Takahisa Mayumi*, Osamu Kemmotsu*, Yoshiteru Kawano**, Hiroshi Wakisaka**, Takezo Ohno**, Takeshi Sugiki**
Authors(kana)
Organization*Department of Anesthesiology,Hokkaido University School of Medicene, **Departments of Anesthesia and Cardiovascular Surgery, Hokkaido Ohno Hospital
JournalCirculation Control
Volume14
Number1
Page71-75
Year/Month1993/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractAnesthetic management of emergency coronary artery bypass graft (CABG) surgery following percutaneous transluminal coronary angioplasty (PTCA) is challenging for anesthesiologists because candidates are usually in high risk. We currently experienced anesthetic management of 10 emergency CABG surgery following PTCA. Emergency CABG was indicated in these 10 cases mainly because of total occlusion of LAD during PTCA procedures. Anesthesia was induced with intravenous administration of small dose of midazolam or diazepam and fentanyl. The trachea was intubated with an aid of pancuronium or vecuronium and mechanical ventilation was initiated. Anesthesia was maintained with low concentrations of enflurane or isoflurane in air/oxygene supplemented by intermittent administration of fentanyl. Infusion of inotrops (dobutamine, dopamine and/or norepinephrine) and vasodilators (nitroglycerin or prostagrandine E1) were used maintain blood pressure and to improve coronary perfusion. Cardiopulmonary bypass was smoothly initiated and emergency CABG was completed with in 3 to 4 hours after the onset of acute coronary occlusion. We experienced no fatal case in our 10 emergency CABG case. The following points are critically important to obtain good outcome in emergency CABG surgery: 1) a team therapy of cardiologists, cardiac surgenes and anesthesiologists is vital, 2) anesthesiologists should be involved in the early stage of evoling miocardial infarction, 3) benzodiazepine-fentanyl-muscle relaxant technique with low concentration of volatile agents may be indicated for emergency CABG for smooth induction and maintaenance of anesthesia, and 4) postoperative intensive care is mandatory.
PracticeBasic medicine
Keywords

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