| Japanese |
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| Title | 閉塞性肥大型心筋症患者の麻酔に際して麻酔深度を脳波により管理した1症例 |
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| Subtitle | 症例 |
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| Authors | 井上聡己*1, 二永英男*1, 川口昌彦*2, 古家仁*2 |
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| Authors(kana) | |
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| Organization | *1大阪脳神経外科病院麻酔科, *2奈良県立医科大学麻酔学教室 |
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| Journal | 循環制御 |
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| Volume | 19 |
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| Number | 1 |
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| Page | 115-118 |
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| Year/Month | 1998/ |
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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」Idiopathic Hypertrophic Subaortic Stenosis(IHSS)を伴った患者の浅側頭動脈-中大脳動脈吻合術(STA-MCA吻合術)の麻酔をneuroleptic analgesia(NLA)による持続静脈麻酔で行った. IHSSは突然死の可能性があり麻酔管理上も前負荷, 後負荷を保ち, 心収縮力亢進を防ぐことが大切とされている. 循環動態への影響をできるだけ小さくするためNLA変法による持続静脈麻酔を選択し, 麻酔深度は脳波をモニタリングすることで管理し得た. また陰性変力作用のある吸入麻酔薬投与時期決定にも脳波が有用であった. 麻酔導入時に不整脈が頻発したがミダゾラムの関与の可能性が考えられた. 「はじめに」Idiopathic Hypertrophic Subaortic Stenosis (IHSS)は肥大型心筋症の一形態で左室の流出路, 流入路に収縮期圧較差を生じる病態であり, うっ血型心筋症に比べ自覚症状が軽症にも関わらず突然死が多いのを特徴としている1). |
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| Practice | 基礎医学・関連科学 |
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| Keywords | IHSS, 持続静脈麻酔, 脳波, Idiopathic hypertrophic subaortic stenosis, Continuous intravenous anesthesia, Electroencephalogram |
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| English |
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| Title | Anesthetic Management of Superficial Temporal Artery-Middle Cerebral Artery Anastomosis with Idiopathic Hypertrophic Subaortic Stenosis Using Electroencephalogram |
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| Subtitle | |
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| Authors | Satoki Inoue*1, Hideo Ninaga*1, Masahiko Kawaguchi*2, Hitoshi Furuya*2 |
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| Organization | *1Department of Anesthesiology, Osaka Neurological Institute, *2Department of Anesthesiology, Nara Medical University |
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| Journal | Circulation Control |
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| Volume | 19 |
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| Number | 1 |
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| Page | 115-118 |
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| Year/Month | 1998/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 64-year-old man with idiopathic hypertrophic subaortic stenosis (IHSS) was scheduled for superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. Anesthesia was induced and maintained with fentanyl and midazolam supplemented with 50% N20 and oxygen and occasional administration of sevoflurane. The depth of anesthesia was monitored electroencephalographically. There were no problems during anesthesia except increases in frequency of arrythmia at the induction. In the anesthetic management of patients with IHSS, it is important to maintain pre- and afterload and avoid cardiac hypercontractility. We think that continuous intravenous administration of fentanyl and midazolam is adequate for the anesthetic management of patients with IHSS because of the strong analgesic and sedative effects and little circulatory effects. Volatile anesthestics are occasionally useful to decrease cardiac hypercontractility. Monitoring of the depth of anesthsesia electroencephalographically was also useful for determining whether to give a volatile anesthetic. Increases in the frequency of arrythmia at the first induction might be related to both reduction of afterload induced by midazolam and midazolam disinhibition reaction. |
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| Practice | Basic medicine |
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| Keywords | Idiopathic hypertrophic subaortic stenosis, Continuous intravenous anesthesia, Electroencephalogram |
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