| Japanese |
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| Title | 麻酔導入後, 循環虚脱を来し, 経食道心エコー図で肥大型心筋症が疑われた一症例 |
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| Subtitle | 症例 |
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| Authors | 鈴木さおり, 野村実, 近藤泉, 長沢千奈美, 鈴木英弘 |
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| Authors(kana) | |
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| Organization | 東京女子医科大学麻酔科学教室 |
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| Journal | 循環制御 |
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| Volume | 17 |
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| Number | 4 |
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| Page | 589-593 |
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| Year/Month | 1996/ |
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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」左室肥大がある72才女性の腹部大動脈瘤に対する人工血管置換術の麻酔導入後, 徐脈, 高度の血圧低下, 不整脈を来し, ドパミン, ノルエピネフリン投与によっても血圧が安定しなかった症例を経験した. 緊急で施行した経食道心エコー図で, 肥大型心筋症(HCM)が疑われた. 患者は術前から脱水状態であり, カテコラミン投与後も心筋肥大による左室内腔・流出路の狭小化のため, 血圧が回復しなかったと考えられた. 再手術では, 術前に充分な輸液をし, セボフルランで導入を行い無事手術を終了した. 高齢者の左室肥大症例ではHCMを念頭におくべきである. また, 術中循環管理を行う上で, 左室収縮能や前負荷の判定に経食道心エコー法は有用であった. 「はじめに」胸腹部大動脈瘤をもつ72才女性の, 腹部に対する人工血管置換術において, フェンタニール, ジアゼパム, パンクロニウムによる麻酔導入後, 徐脈, 高度の血圧低下, 不整脈を来し, ドパミン, ノルエピネフリンなどの昇圧薬への反応も悪く手術を延期した症例を経験した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Hypertrophic Cardiomyopathy, Anesthetic Management, Aortic Aneurysm |
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| English |
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| Title | Accidental Hypotension after Fentanyl-Diazepam Induction in Patients with Undiagnosed Hypertrophic Cardiomyopathy |
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| Authors | Saori Suzuki, Minoru Nomura, Izumi Kondo, Chinami Nagasawa, Hidehiro Suzuki |
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| Authors(kana) | |
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| Organization | Department of Anesthesiology, Tokyo Women's Medical College |
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| Journal | Circulation Control |
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| Volume | 17 |
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| Number | 4 |
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| Page | 589-593 |
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| Year/Month | 1996/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 72-year-old woman was scheduled for graft replacement of abdominal aortic aneurysm. After induction of anesthesia and tracheal intubation with diazepam 10mg, fentanyl 0.5μg and pancuronium 6mg, her systolic blood pressure decreased to 50mmHg, and heart rate to 50 beats/min, and ventricular arrhythmia was noted. Metaraminol and calcium chloride administration restored the preoperative blood pressure transitionally, but dopamine 10μg/kg/min and norepinephrine 0.05μg/kg/min were necessary to maintain her blood pressure. Immediately performed transesophageal echocardiography (TEE) findings suggested hypertrophic cardiomyopathy (HCM) and the operation was postponed. It was suggested that hypotension after induction of anesthesia enhanced the obstruction of the left ventricle outflow tract. Accordingly in the following operation 2 weeks after the above episode, pre-load was maintained by preoperative fluid infusion, and induction by sevoflurane was successfully adjusted to keep sinus rhythm and avoid hyperdynamic contractility which would lead to hypotension and arrhythmia. TEE was found to be a useful monitor to control perioperative hemodynamics in patients with HCM. (Circ Cont 17：589〜593, 1996) |
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| Practice | Basic medicine |
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| Keywords | Hypertrophic Cardiomyopathy, Anesthetic Management, Aortic Aneurysm |
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