Japanese
Title心筋梗塞患者の胃全摘術におけるIABPの使用経験
Subtitle症例
Authors池田東美明, 世良田和幸, 外丸輝明
Authors(kana)
Organization昭和大学藤ガ丘病院麻酔科
Journal循環制御
Volume17
Number3
Page418-421
Year/Month1996/
Article報告
Publisher日本循環制御医学会
Abstract「要旨」今回はIABP作動下に胃全摘術を施行した心筋梗塞既往患者の麻酔を経験した. 症例は60歳男性で, 近医にて胃癌を指摘され当院へ紹介入院となる. 負荷心電図は陰性所見であったが, 心エコー図では駆出率15.3%, 左室腔拡大, 中隔から心尖部にかけてakinesis, 左室後壁は代償性のhyperkineticな所見を示した. 麻酔導入後経皮的にIABPカテーテルを挿入, 術中作動させることで無事に胃全摘術を終了した. 術後の循環動態が安定しているため当日IABPを抜去し, 経過良好なため1ヵ月後に退院した. 重症心疾患患者の非心臓手術において, IABPの使用がましているが合併症に注意しなければならない. 今回は, 比較的細いカテーテルとイントロデュサーを用い硬膜外麻酔を併用することで下肢虚血の防止に努めた. また虚血の早期発見のためにパルスオキシメーターを下肢の指に装着して虚血の早期発見にも努めた. 今回心エコー図を循環動態の術前評価に用いたが, IABPの適応として従来の基準に加えて心エコー所見を加えることでその適応は拡大されると思われた.
Practice基礎医学・関連科学
KeywordsNon-cardiac surgery, Anesthetic management, Intra-aortic balloon pump
English
TitleAnesthetic Management of Gastrectomy in a Patient with Old Myocardial Infraction using Intra-aortic Balloon Pump
Subtitle
AuthorsTomiaki Ikeda, Kazuyuki Serada, Teruaki Tomaru
Authors(kana)
OrganizationDepartment of Anesthesiology, Showa University Fujigaoka Hospital
JournalCirculation Control
Volume17
Number3
Page418-421
Year/Month1996/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractWe experienced a case of anesthetic management of gastric cancer with old myocardial infraction using intra-aortic balloon pump (IABP). A 60 year-old male who had severe cardiac dysfunction (LVEF=15.3 % on echocardiograpy) came to surgery under general anesthesia. General anesthesia was induced by fentanyl, midazolam, and vecuronium and maintained by isoflurane 0.5 %, nitrous oxide 50 % and oxygen combined with thoracic epidural anesthesia. Before starting operation, an IABP catheter was inserted and thereafter circulation conditions were normolized until operation was over. One month later he was discharged without any complications. IABP was a useful divice for stabilization of circulatory dysfuction but it has many complications including a major complication such as ischemia in the lower limbs. To decrease the episode of ischmia, we used a small diameter introducer sheath for IABP, and a pulse oxymeter for the detection of ischmia in the lower limbs. IABP was expensive, but an effective divice in perioperative management of patients with severe cardiac dysfunction. We think that the assesment of cardiac function by echocardiogram is essential and important as the additional indication of IABP. (Circ Cont 17：418〜421, 1996)
PracticeBasic medicine
KeywordsNon-cardiac surgery, Anesthetic management, Intra-aortic balloon pump

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