| Japanese |
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| Title | 術前に向精神薬投与を受けていた患者における術中重症低血圧の一例 |
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| Subtitle | 症例 |
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| Authors | 須山豪通, 松本千香子, 山野上敬夫, 向田圭子, 佐々木宏, 弓削孟文 |
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| Authors(kana) | |
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| Organization | 広島大学医学部麻酔・蘇生学教室 |
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| Journal | 循環制御 |
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| Volume | 16 |
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| Number | 3 |
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| Page | 387-390 |
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| Year/Month | 1995/ |
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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」向精神薬を常用している症例において, 周術期に突然の重篤な低血圧, 心停止1,2), 低酸素血症, 呼吸停止, イレウス1)などの重篤な合併症を認めたとの報告がある. 今回, 術前に向精神薬を大量に服用していた患者が術中に重症低血圧に陥った症例を経験した. 「症例」症例は68歳女性で, 身重153cm, 体重43.2kgであった. 既往歴としては42歳時に脳動脈瘤破裂に対し脳動脈瘤手術を受けていた. また51歳時に幻覚妄想状態が発現し, 精神分裂病の診断を受けた. これに対し以後17年間, 大量の向精神薬の投与を受けていた. 1日投与量はクロルプロマジン375mg, プロメタジン150mg, フェノバルビタール340mg, ニメタゼパム5mg, およびトリアゾラム0.25mgにのぼり, 特にクロルプロマジンとフェノバルビタールは一般服用量の上限を越えていた. 未治療の高血圧症を有していたが, 心電図, 胸部X線写真, および心エコー図に異常所見は認められなかった. 家族歴に特記すべきことはなかった. 現病歴であるが, 神経内科に入院中に胸部単純X線写真にて右上前縦隔に異常陰影を指摘された. 精査の結果, 胸腺腫と診断され, 胸腺摘出術が予定された. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Major tranquillizers, Circulatory collapse, Schizophrenia |
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| English |
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| Title | Critical and Persistent Intraoperative Hypotension in a Patient who Had Been Administered Major Tranquillizers for Schizophrenia Preoperatively |
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| Authors | Hidemichi Suyama, Chikako Matsumoto, Takao Yamanoue, Keiko Mukaida, Hiroshi Sasaki, Osafumi Yuge |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology and Critical Care Medicine, Hirosima University School of Medicine |
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| Journal | Circulation Control |
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| Volume | 16 |
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| Number | 3 |
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| Page | 387-390 |
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| Year/Month | 1995/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | We report critical and persistent intraoperative hypotension in a patient who had been administered major tranquillizers for schizophrenia preoperatively. The patient was 68-year-old female, and thymectomy under general anesthesia with epidural block was scheduled. Preoperative electrocardiography and echocardiography revealed no abnormalities. Ninety minutes after the beginning of the surgery, sudden profound hypotension (40/20mmHg) and bradycardia (40bpm) occurred. Administration of ephedrine, dopamine, and dobutamine did not restore hypotension, and only transient recovery of blood pressure was obtained by phenylephrine. The pericardium was released, and very poor contraction of the heart was observed. Stable hemodynamics recovered gradually by a continuous administration of norepinephrine, and the surgery was completed. Her post operative course was uneventful. In this report, we observed very poor cardiac contraction, and this may contribute mainly to the sudden perioperative circulatory collapse in the patient who had been administerd major tranquillizers before surgery. (Circ Cont 16：387〜390, 1995) |
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| Practice | Basic medicine |
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| Keywords | Major tranquillizers, Circulatory collapse, Schizophrenia |
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