Japanese
Title透析患者の術前水分管理と麻酔下における心機能測定
Subtitle原著
Authors沼澤理絵, 中尾康夫
Authors(kana)
Organization（医）北楡会札幌北楡病院麻酔科
Journal循環制御
Volume23
Number4
Page416-419
Year/Month2002/
Article原著
Publisher日本循環制御医学会
Abstract著者らの施設では全身麻酔を予定された透析患者の術前日除水量を通常の2/3程度に設定している. 透析患者の全身麻酔下における心拍出量および循環血液量を測定し, 心機能の面から術前除水量に関して検討した. 維持透析症例54例, 腎機能正常症例20例において麻酔導入後パルス式色素希釈法により心機能測定を行った. 透析症例の心拍出量, 一回拍出量は腎機能正常症例と同程度に保たれていた. 体重当たりの循環血液量は透析症例において有意に増加していた. 前日の透析時に除水量を少なく設定した場合, 全身麻酔下においても心拍出量は保たれ, 血圧低下を抑制する方向に働くと考えられる.
Practice基礎医学・関連科学
KeywordsHemodialysis patients, Fluid removal volume, Cardiac output, Blood volume, General anesthesia
English
TitleCardiac Function Under General Anesthesia in Chronic Hemodialysis Patients
Subtitle
AuthorsRie Numazawa, Yasuo Nakao
Authors(kana)
OrganizationDepartment of Anesthesiology, Sapporo Hokuyu Hospital
JournalCirculation Control
Volume23
Number4
Page416-419
Year/Month2002/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractHemodynamic control of chronic hemodialysis （HD） patients is difficult under general anesthesia. We set up the preoperative fluid removal level at about 2/3 less than the usual fluid removal. We have reported that decrease of blood pressure during general anesthesia can be prevented in that way. There are some opinions about the volume of preoperative fluid removal. Accordingly, we measured blood volume（BV） and cardiac output （CO） under general anesthesia, and evaluated the conditions of preoperative fluid removal. We evaluated 54 HD patients and 20 control patients undergoing scheduled operations. On preoperative dialysis with HD patients, fluid removal was performed to dry weight with an additional 1/3 of the usual body weight increase. Time from the end of dialysis to anesthesia induction was 18-22 hrs. After induction of anesthesia with propofol/sevoflurane/nitrous oxide, CO and BV were measured by pulse dye-densitometry. Mean cardiac index （CI） was 3.25±1.21l/min/m2 in the HD patients and 2.90±0. 85l/min/m2 in control patients. Mean BV of HD patients was 77.9±13.7ml/kg, which was significantly larger than 70.7±11.5 ml/kg in control patients. Thirteen （24％） of the HD patients presented hypotension under anesthesia. We consider that we can preserve CO in HD patients undergoing general anesthesia by reducing the volume of preoperative fluid removal , which helps to prevent severe hypotension.
PracticeBasic medicine
KeywordsHemodialysis patients, Fluid removal volume, Cardiac output, Blood volume, General anesthesia

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