| Japanese |
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| Title | 経食道心エコー図と肺動脈カテーテルとの併用が麻酔管理に有用であった褐色細胞腫の一例 |
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| Subtitle | 症例 |
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| Authors | 河野圭*, 野村岳志**, 洪淳憲*, 土井克史*, 小坂義弘** |
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| Authors(kana) | |
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| Organization | *国立呉病院麻酔科, **島根医科大学麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 16 |
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| Number | 4 |
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| Page | 567-570 |
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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 | 「要旨」褐色細胞腫摘出術に, 経食道心エコー図(TEE)と肺動脈カテーテル(PAカテ)とを用いて麻酔管理を行った. 症例は53歳, 女性. 麻酔は硬膜外麻酔併用全身麻酔を選択した. 腫瘍摘出操作中は, カテコルアミンの分泌増加によると思われる心拍出量の減少, TEEの左室短軸像で左室収縮終期/拡張終期面積比の低下などを認めたが, 腫瘍摘出後は輸液, 輸血, 昇圧薬をTEEとPAカテの情報を指標にして投与することで, 安定した血行動態を保つことができた. PAカテによる定量的な情報に加え, TEEによる定性的な心機能の評価をリアルタイムで行うことは, 褐色細胞腫の麻酔管理に大変有用であると思われた. 「はじめに」褐色細胞腫摘出術の麻酔では, 急激な血行動態の変化を伴うため, その循環管理には細心の注意が必要になる. 各種の血管作働薬を適切に使用することもさることながら, 術中の心血管系の機能を迅速に把握することは, 麻酔管理をする上で, 大変重要なことである. 今回我々は, 従来の肺動脈カテーテル(以下PAカテと略す)に加えて, 経食道心エコー図(以下TEEと略す)による心機能のモニタリングとが麻酔管理に有用であった症例を経験したので報告する. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Pheochromocytoma, Transesophageal echocardiography, Pulmonary artery catheter, Anesthesia. |
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| English |
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| Title | A Case Report of Anesthetic Managenent of Pheochromocytoma with Transesophageal Echocardiography and A Pulmonary Artery Catheter |
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| Authors | Kei Kohno, Takeshi Nomura*, Junken Koh, Katsushi Doi, Yoshihiro Kosaka* |
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| Authors(kana) | |
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| Organization | Department of Anesthesia, Kure National Hospital, *Department of Anesthesiology, Shimane Medical University |
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| Journal | Circulation Control |
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| Volume | 16 |
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| Number | 4 |
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| Page | 567-570 |
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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 used transesophageal echocardiography (TEE) and pulmonary artery catheter for anesthetic management on a case of a 53-year-old woman who had underwent removal of pheochromocytoma. Anesthesia was maintained with nitrous oxideoxygen-isoflurane and epidural blockade. Nitroglycerine was also administered continuously for the control of hypertension. Blood pressure, howerer, was up and down during the manipulation of the tumor. Decreased cardiac output (from 5.15 to 3.17 1/min) and mixed venous oxygen saturation from 72% to 54% due to increased catecholamines during surgery. We put TEE at the mid-papillary level to view the short axis of the left ventricle. The calculated fractional area change (FAC) was also evaluated after surgery. The wall motion, which was hypokinetic at around anterior septum area, become normokinetic and FAC returned to 30-35% from 20-30% after the tumor resection. Because of such a good recovery of the left ventricular function, there was no need of catecholamines but blood transfusion. Additional fluid administration, the dose of which was decided based on end-diastolic volume, enabled us to keep blood pressure relatively stable during the rest of the surgery. We conclude that TEE, as well as a pulmonary artery catheter, is a useful modality for anesthetic management of pheochromocytoma to monitor the real-time left ventricular function. (Circ Cont 16：567〜570, 1995) |
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| Practice | Basic medicine |
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| Keywords | Pheochromocytoma, Transesophageal echocardiography, Pulmonary artery catheter, Anesthesia. |
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