| Japanese |
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| Title | 小児開心術における早期抜管―インフルラン併用少量フェンタニール麻酔法とストレス関連ホルモンへの影響― |
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| Subtitle | 原著 |
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| Authors | 金子武彦, 大脇明, 鈴木玄一, 橋口さおり |
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| Organization | 東京都立清瀬小児病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 15 |
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| Number | 3 |
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| Page | 421-429 |
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| Year/Month | 1994/ |
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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」小児開心術に対して, 笑気・酸素・セボフルランの緩徐導入後, イソフルラン・笑気に少量のフェンタニールを組み合わせて麻酔管理を行った. 手術室での術直後の抜管を考慮した際のフェンタニール使用量は11〜13μg/kgで, 導入時に3〜4μg/kg, 体外循環開始までに総量の8割を投与し良好な結果を得た. 本法によるストレス関連ホルモンの推移を従来のモルヒネ麻酔と比較すると, 執刀によるエピネフリン濃度の一過性の上昇は抑制することができなかったものの, ACTH, ノルエピネフリン濃度は体外循環開始までは正常範囲内で推移した. しかも, 心拍数, 血圧は本法で若干上昇する傾向にあったが臨床的には問題がなかった. 大量麻薬による麻酔法でもストレス反応を抑制できるのは体外循環開始まででしかない現状では, 我々が行った少量のフェンタニールでも, 吸入麻酔薬の利点を活かして併用すれば臨床的には危険性は少なく実用に耐え得ることが示唆された. また, 本法施行に際しては, 疾患, 年齢, 体重といった術前因子とともに体外循環時間や肺血管, 気道の問題も充分考慮に入れ, 慎重な症例の選択が望ましい. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Early Extubation, Fentanyl, Inhalation Anesthesics, Pediatric Cardiac Surgery, Catecholamines |
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| English |
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| Title | Early Extubation after Pediatric Open Heart Surgery ―Low-dose Fentanyl Combined with Inhalation Anesthetics and Its Effect on Hemodynamics or Stress Hormone Response― |
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| Subtitle | Original article |
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| Authors | Takehiko Kaneko, Akira Ohwaki, Gen'ichi Suzuki, Saori Hashiguchi |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology, Tokyo Metropolitan Kiyose Children's Hospital |
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| Journal | Circulation Control |
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| Volume | 15 |
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| Number | 3 |
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| Page | 421-429 |
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| Year/Month | 1994/ |
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| Article | Original article |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Changing from a routine of overnight mechanical ventilation to early extubation after cardiac surgery recently comes to reevaluate high-dose opioid anesthesia. We recommended in this study low-dose fentanyl anesthesia combined with nitrous oxide, isoflurane and muscle relaxant as the regimen for early extubation after open heart surgery compared with high-dose morphine technique as a conventional method. Adequate dosage of fentanyl was 11 〜 13 μg/kg totaly and about 80% of it was administered prior to cardiopulmonary bypass (CPB). Though hemodynamics such as heart rate and blood pressure in this method were slightly higher than in morphine anesthesia, the changes of vital signs were almost stable. Plasma concentration of hormones associated with stress were also within normal ranges prior to CPB except for epinephrine just after the beginning of operation and cortisol affected by methyl prednisolone administration before CPB. Under the present condition that even if high-dose opioid anesthesia can supress the stress hormone responses before CPB not after initiation of CPB, if we put the advantage of inhalation agents such as isoflurane to practical use, lowdose fentanyl technique we recommended can be a safe procedure and facillitate extubating at the earliest opportunity. Also both pre- and intraoperative factors should be considerations in achievement early extubation, such as types of heart diseases, age, body weight, duration of CPB, pulmonary vascular status and airway conditions. |
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| Practice | Basic medicine |
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| Keywords | Early Extubation, Fentanyl, Inhalation Anesthesics, Pediatric Cardiac Surgery, Catecholamines |
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