| Japanese |
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| Title | 肥大型心筋症患者のイレウス手術の麻酔経験 |
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| Subtitle | 症例 |
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| Authors | 小林敏信, 荒井恭子, 渡邊興次 |
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| Authors(kana) | |
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| Organization | 静岡市立静岡病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 21 |
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| Number | 1 |
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| Page | 91-95 |
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| Year/Month | 2000/ |
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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 | 「はじめに」 肥大型心筋症(HCM)では左室容量, 心拍数, 心調律や血圧のわずかの変化に対しても感受性が高く1), 麻酔中の循環管理は困難が予想される. HCM患者の非心臓手術のリスクは高くないとする報告2)もあるが重篤な合併症や死亡例の報告3, 4)もある. 今回, 著者らはHCM患者のイレウス手術の麻酔中に心室頻拍(VT)を起こした症例を経験したので報告する. 「症例」 患者は75歳の男性, 身長167cm, 体重56kg. 既往歴:43歳の時, 人間ドックで心筋症を指摘されたが治療をしなかった. 72歳, 74歳の時VT, HCMの診断で本院内科入院. 現病歴:平成11年2月1日 突然の腹痛にて他院受診, 症状改善. 2月4日 再び腹痛にて本院受診, 腹部X線写真にてイレウスと診断. 手術前日, 非持続性心室性頻拍(nonsustained VT, 以下NSVT)が多発し, 手術を延期し, high care unit(HCU)にて循環動態の改善に努めた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | |
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| English |
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| Title | Nonsustained Ventricular Tachycardia Following Antagonism of Neuromuscular Blockade in a Patient with Hypertrophic Cardiomyopathy. |
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| Subtitle | |
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| Authors | Toshinobu L.Kobayashi, Kyoko Arai, Kouji Watanabe |
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| Authors(kana) | |
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| Organization | Departmemt of Anestheia,Shizuoka City Hospital |
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| Journal | Circulation Control |
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| Volume | 21 |
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| Number | 1 |
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| Page | 91-95 |
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| Year/Month | 2000/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 75-year-old male with hypertrophic cardiomyopathy (HCM) was scheduled for ileus operation. Twenty-four hours Holter electrocardiography revealed frequent ventricular ectopics with nonsustained ventricular tachycardia. The patient was premedicated with midazolam 2 mg intramuscularly before operation. Intravenous infusion of xylocaine 60 mg/h and propranolol 0.5 mg/h were started before opration and continued throughout the perioperative period. Anesthesia was induced with vecuronium 1 mg, fentanyl 0.3 mg, propofol 120 mg and suxamethonium 80 mg. An initial high arterial pressure of 201/91 mmHg decreased to 129/72 mmHg after induction. After tracheal intubation arterial pressure continued to decrease to 75/55 mmHg. This was treated with bolus of 100 mg of ketamine and 0.4 mg of phenylephrine. Anesthesia was maintained with propofol at a rate of 4 mg/kg/h. The cardiovascular variables were fairly unstable especially after discontinuation of propofol. After antagonism of neuromuscular blockade with atropine 0.3 mg and neostigmine 0.8 mg, heart rate increased to 185 bpm and nonsustained ventricular tachycardia was induced. |
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| Practice | Basic medicine |
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| Keywords | Hypertrophic cardiomyopacy, Ventricular tachycardia, Reversal of relaxation |
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