| Japanese |
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| Title | Bispectral Index上昇時に発症した冠動脈攣縮の1症例 |
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| Subtitle | 症例 |
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| Authors | 本多泰子, 日野博文, 西木戸修, 笹野淳, 小幡由美, 舘田武志 |
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| Organization | 聖マリアンナ医科大学麻酔学教室
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| Journal | 循環制御 |
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| Volume | 26 |
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| Number | 4 |
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| Page | 335-337 |
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| Year/Month | 2005/12 |
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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 | 手術中に冠動脈攣縮を起こした症例の報告は多いが1〜8), 浅麻酔が原因である客観的なデータを示した報告は少ない1, 9). 今回術中にbispectralindex(BIS)値が上昇した浅麻酔状態において冠動脈攣縮と思われるST上昇を認めた症例を経験したので報告する. 症例 73歳の男性. 身長169cm, 体重64kg. 原発性肺腺癌の診断で, 左肺上葉切除術が予定された. 既往歴として40歳から異型狭心症で胸痛発作を頻回に起こしていたが最近5年間は症状を認めなかった. 術前検査では, 心電図で完全右脚ブロックを認めるのみであった. 手術室入室30分前にアトロピン0.5mgを筋注した. 麻酔導入前に, 硬膜外カテーテルを第6/7胸椎間より挿入した. フェンタニル, プロフォール(Target Control Infusion；TCI)で麻酔導入を行い, ベクロニウムで筋弛緩を得た後, 右用37Fr二腔気管支チューブを気管挿管した. 術中は通常のモニターに加え, 観血的動脈圧とBIS値をモニタリングした. 麻酔維持は酸素‐亜酸化窒素-プロポフォール(TCI2〜3μg/ml)-フェンタニル(総投与量0.2mg)で行い, BIS値を40〜50台で維持した. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | A Case of Coronary Artery Spasm Possibly due to Inadequate Anesthesia as Indicated by Bispectral Index |
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| Authors | Yasuko HONDA, Hirofumi HINO, Osamu NISHIKIDO, Jun SASANO, Yumi OBATA, Takeshi TATEDA |
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| Organization | Department of Anesthesiology, St.Marianna University, School of Medicine
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| Journal | Circulation Control |
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| Volume | 26 |
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| Number | 4 |
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| Page | 335-337 |
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| Year/Month | 2005/12 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A case of coronary artery spasm that occurred during inadequate anesthesia, as indicated by the bispectral index (BIS) is described. A 73-year-old man with a history of variant angina was scheduled for left upper lobectomy because of lung cancer. Surgery was to be performed under general anesthesia combined with thoracic epidural anesthesia. Preoperative examination showed only complete right bundle branch block on the electrocardiogram (ECG). Anesthesia induction and intubation were uneventful. Anesthesia was maintained with nitrous oxide in oxygen, propofol and epidural block. The patient's systolic arterial pressure decreased suddenly to about 70mmHg upon surgical manipulation of the heart, but there was no remarkable ST-T change on the ECG. The administration of propofol was terminated, and 5mg of ephedrine was injected with 100% oxygen. The BIS rose from 40 to 70. After normal systemic pressure was achieved, the ECG showed ST segment elevation. Isosorbide and nicorandil were administered, and the ST segment returned to normal. It is possible that the inadequate anesthesia, the administration of ephedrine, or both were the cause of the coronary artery spasm in this case. We should be aware of the possibility of coronary artery spasm under these conditions. |
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| Practice | Basic medicine |
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| Keywords | coronary spasm, bispectral index : BIS, inadequate depth of anesthesia |
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