| Japanese |
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| Title | 拡張型心筋症患者の麻酔経験 |
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| Subtitle | 症例 |
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| Authors | 瀧田恒一*, 合田由紀子**, 真尾秀幸**, 河東寛**, 劔物修* |
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| Authors(kana) | |
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| Organization | *北海道大学医学部麻酔学講座, **市立札幌病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 15 |
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| Number | 2 |
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| Page | 296-300 |
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| Year/Month | 1994/ |
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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」2例の拡張型心筋症(DCM)を合併する患者のイソフルランによる麻酔管理を経験した. 症例1では, はじめGO-フェンタニールで麻酔を維持したが, 浅麻酔が原因と考えられる循環抑制をきたしたためイソフルラン(1.0〜1.5％)を加えた. 症例2では, GO-イソフルラン(1.0〜1.5％)に硬膜外麻酔を併用した. DCMでは吸入麻酔薬は避けるべきとされているが, 本症例では, イソフルラン(1.0〜1.5％)は血行動態を悪化させることなく使用できた. またDCM麻酔管理では循環動態の厳重なモニタリングが必要であるが, 特にSvO2の連続モニタリングが心ポンプ機能の変化を早期に知るうえで有用であった. 拡張型心筋症は, 左室, 時に右室の拡張と収縮性の低下を主体とする心筋症であり, 臨床的には心拡大, 心不全, 高度の不整脈を認める. 今回, 拡張型心筋症を合併した患者の麻酔を経験したので, その麻酔経過と麻酔, 手術中の血行動態について報告する. 血行動態は以下の方法で測定した. 手術室入室後, 麻酔導入前に局麻下で右橈骨動脈に観血的血圧測定用カテーテルを, 右鎖骨下静脈より肺動脈カテーテルを挿入し, 動脈圧(ABP；収縮期血圧：SBP, 拡張期血圧：DBP), 中心静脈圧(CVP), 肺動脈圧(PAP), 肺動脈楔入圧(PCWP), 混合静脈血酸素飽和度(SvO2)をモニタリングした. また, 心拍出量(CO)を熱希釈法により測定し, 心係数(CI), 1回拍出係数(SI), 体血管抵抗(SVR)を計算した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | dilated cardiomyopathy, isoflurane, hemodynamics |
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| English |
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| Title | Hemodynamics During Isoflurane Anesthesia in two Patients with Dilated Cardiomyopathy |
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| Subtitle | |
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| Authors | Koichi Takita*, Yukio Goda**, Hideyuki Mashio**, Hiroshi Kawahigashi**, Osamu Kemmotsu* |
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| Authors(kana) | |
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| Organization | *Departments of Anesthesiology,Hokkaido University School of Medicine, **Sapporo City Hospital |
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| Journal | Circulation Control |
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| Volume | 15 |
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| Number | 2 |
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| Page | 296-300 |
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| Year/Month | 1994/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | In two patients with dilated cardiomyopathy (DCM) hemodynamics during isoflurane anesthesia were evaluated. One case was a 42-years-old male who underwent total thyroidectomy. Anesthesia was induced with midazolam 10 mg IV and fentanyl 0.2 mg IV, and was maintained with Go-fentanyl at first, but isoflurane 1.0〜1.5 % was added because the depth of anesthesia was insufficient. Another case was a 59-years-old female who underwent sigmoidectomy. Anesthesia was induced with midazolam 5 mg IV and fentanyl 0.2 mg IV, and was maintained with isoflurane 1.0〜1.5 % in nitrous oxide 60% and oxygen, and epidural anesthesia. Generally inheled anesthetics are thought to be not desirable for patients with DCM because of their negative inotoropic effects. But in our patients their hemodynamics did not become worse under isoflurane anesthesia. So we think that isoflurane is allowed to be used for patients with DCM whose cardiac function are not impaired so much. The perioperative management of patients with DCM is essential to the keen monitoring of cardiovascular function. Continuous SvO2 monitoring is much useful in our cases because we can perceive the continuous change of cardiac pump function. |
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| Practice | Basic medicine |
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| Keywords | dilated cardiomyopathy, isoflurane, hemodynamics |
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