| Japanese |
|---|
| Title | フェンタニール麻酔中に頸部過伸展, 両下肢挙上により完全房室ブロック・心停止に至った1症例 |
|---|
| Subtitle | 症例 |
|---|
| Authors | 小島琢, 河東寛, 合田由紀子, 真尾秀幸, 伊東義忠, 加藤学 |
|---|
| Authors(kana) | |
|---|
| Organization | 市立札幌病院麻酔科 |
|---|
| Journal | 循環制御 |
|---|
| Volume | 18 |
|---|
| Number | 1 |
|---|
| Page | 95-99 |
|---|
| Year/Month | 1997/ |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御医学会 |
|---|
| Abstract | 「要旨」53才, 男性. 大動脈弁狭窄, 僧帽弁および三尖弁閉鎖不全症, 冠動脈左回旋枝狭窄に対し2弁置換術, 三尖弁形成術およびCABG1枝が予定された. 麻酔導入および挿管前後の血行動態は安定していたが, 頸部過伸展・両下肢挙上を契機に完全房室ブロック, 心停止に至った. フェンタニール, ベクロニウムによる迷走神経の緊張亢進に急激な体位変換が加わり, 迷走神経の過剰反射が誘発されたため, 術前より認められたI度房室ブロックが完全房室ブロックに至ったものと推察された. 「はじめに」術中の心停止については種々の報告1)がされているが, 神経反射が原因と考えられる心停止の報告は比較的少ない. 今回, フェンタニール麻酔中に頸部過伸展・両下肢挙上を契機として2回の完全房室ブロック, 心停止に至った症例を経験したので, 若干の文献的考察を加えて報告する. 「症例」53才, 男性. 身長156cm, 体重57kg. 診断：大動脈弁狭窄症(AS), 僧帽弁閉鎖不全症(MR), 三尖弁閉鎖不全症(TR), 虚血性心疾患. |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | Postural change, Vagal reflex, Complete AV block, Asystole |
|---|
| English |
|---|
| Title | Overextension of the Neck and Lifting of the Lower Limbs Caused Complete AV Block and Asystole during Fentanyl Anesthesia |
|---|
| Subtitle | |
|---|
| Authors | Taku Kojima, Hiroshi Kawahigashi, Yukiko Goda, Hideyuki Mashio, Yoshitada Ito, Manabu Kato |
|---|
| Authors(kana) | |
|---|
| Organization | Department of Anesthesiology, Sapporo City General Hospital |
|---|
| Journal | Circulation Control |
|---|
| Volume | 18 |
|---|
| Number | 1 |
|---|
| Page | 95-99 |
|---|
| Year/Month | 1997/ |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | A 53-year-old man was scheduled for aortic and mitral valve replacement, tricuspid valve plasty, and coronary artery bypass graft because of aortic stenosis, mitral and tricuspid regurgitation. The patient originally had 1st degree AV block. Anesthesia was induced and maintained with high-dose fentanyl, vecuronium, midazolam, and oxygen-air (FIO2：0.5). Tracheal intubation was performd without any problem. Soon after overextension of his neck sudden complete AV block and asystole were noticed, which responded to intravenous atropine 0.5 mg and ephedrine 8 mg, and followed by sinus rhythm shortly. Fifteen minutes after the first episode, his lower limbs were lifted for sterilization and complete AV block and asystole were again observed, which were treated with atropine 1.0 mg, ephedrine 8 mg, and epinephrine 0.2 mg and cardiac massage. Acceptable hemodynamic state was obtained after 200 seconds after the episode, and the subsequent anesthesia course was uneventful for the proposed surgery. No neurological deficit was observed postoperatively. We speculated that these episodes were most likely induced by vagal reflex being triggered by postural changes under the combined use of fentanyl and vecuronium. (Circ Cont 18：95〜99, 1997) |
|---|
| Practice | Basic medicine |
|---|
| Keywords | Postural change, Vagal reflex, Complete AV block, Asystole |
|---|