| Japanese |
|---|
| Title | 等頻度房室解離の出現で低血圧を呈したEbstein奇形の麻酔経験 |
|---|
| Subtitle | 症例 |
|---|
| Authors | 市川眞紀子*, 小出康弘** |
|---|
| Authors(kana) | |
|---|
| Organization | *藤沢市民病院麻酔科, **横浜市立大学医学部附属病院麻酔科 |
|---|
| Journal | 循環制御 |
|---|
| Volume | 22 |
|---|
| Number | 4 |
|---|
| Page | 370-374 |
|---|
| Year/Month | 2001/ |
|---|
| Article | 報告 |
|---|
| Publisher | 日本循環制御医学会 |
|---|
| Abstract | プロポフォール麻酔中に等頻度房室解離が出現し, 循環虚脱を呈したEbstein奇形の麻酔を経験したので報告する. 等頻度房室解離は麻酔中しばしば見られる不整脈であり通常血行動態に影響を及ぼすことは少ないが, 今回の症例では著明な血圧低下を呈した. 心不全のない軽症Ebstein奇形では, 通常問題とならない不整脈が循環動態に大きな影響を及ぼす危険性をはらんでおり, 麻酔に際しては注意が必要である. 「症例」60歳の女性, 身長156.8cm, 体重60.0kg. 幼少時より心雑音を指摘されており, 20歳時にEbstein奇形と診断された. 5ヶ月前に左総腸骨動脈閉塞症の既往がある. 家族歴に特記すべきことはなかった. 4ヶ月前に卵巣癌と診断され全身麻酔下(GOS＋硬膜外麻酔)に根治術を行った. 今回, 化学療法後のセカンドルック手術が予定された. 術前の血圧は132/86mmHg, 心拍数は68/分, 心電図に特記すべき所見はなかった. |
|---|
| Practice | 基礎医学・関連科学 |
|---|
| Keywords | Ebstein's anomaly, Isorhythmic dissociation, General anesthesia, Propofol |
|---|
| English |
|---|
| Title | Isorhythmic Dissociation Caused a Severe Hypotension in a Patient with Ebstein's Anomaly During General Anesthesia |
|---|
| Subtitle | |
|---|
| Authors | Makiko Ichikawa*, Yasuhiro Koide** |
|---|
| Authors(kana) | |
|---|
| Organization | *Department of anesthesiology, Fujisawa City Hospital, **Department of anesthesiology, Yokohama City University Hospital |
|---|
| Journal | Circulation Control |
|---|
| Volume | 22 |
|---|
| Number | 4 |
|---|
| Page | 370-374 |
|---|
| Year/Month | 2001/ |
|---|
| Article | Report |
|---|
| Publisher | Japan Society of Circulation Control |
|---|
| Abstract | A 60-year-old woman with Ebstein's anomaly, diagnosed 40 years ago underwent a second look surgery for the ovarian cancer. She had no history of cardiac arrhythmias and heart failure. After an epidural catheter was placed, general anesthesia was induced and maintained with propofol and fentanyl. Three hours following induction of anesthesia a suddenly decrease in arterial blood pressure from 100/48 to 58/36 mmHg was noted. At the same time, a change from sinus rhythm to isorhythmic A-V dissociation was noted. Four minutes later, the ECG showed normal sinus rhythm, and consequently blood pressure was recovered. Other three similar events occurred during surgery. Isorhythmic A-V dissociation is usually tolerated without hemodynamic compromise in healthy individuals. However, isorhythmic A-V dissociation can occasionally result in severe hypotension in patients with impaired cardiac function such as Ebstein's anomaly. Careful ECG monitor should be necessary. As the etiology of isorhythmic A-V dissociation is varied, it is difficult to decide specific treatments. When isorhythmic A-V dissociation is necessary to be treated, choice of anesthetic technique or cardiovascular drugs should be considered according to possible mechanism. |
|---|
| Practice | Basic medicine |
|---|
| Keywords | Ebstein's anomaly, Isorhythmic dissociation, General anesthesia, Propofol |
|---|