| Japanese |
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| Title | 手術室抜管を目指した心臓血管外科手術の麻酔(レミフェンタニルを用いたファーストトラック麻酔) |
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| Subtitle | 症例 |
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| Authors | 中川雅史*, 内藤京子*, 上農喜朗** |
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| Authors(kana) | |
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| Organization | *社会保険紀南病院麻酔科, **兵庫医科大学麻酔科 |
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| Journal | 循環制御 |
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| Volume | 29 |
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| Number | 1 |
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| Page | 71-75 |
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| Year/Month | 2008/5 |
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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」予定心臓手術において術後早期の抜管を目指したファーストトラック麻酔は, ICU滞在期間の短縮, コスト削減, 資源の有効利用など主に経済的な利点から推奨されてきた. 死亡率, 合併症に関しても従来の高用量オピオイド麻酔と比べても増加しないことが示され1,2), 予定心臓手術に対する標準的な麻酔法になってきた. 当院では, 従来から予定心臓血管手術においてプロポフォールと中用量フェンタニル(10〜20μg/kg)麻酔を用いて早期抜管を目指してきた. 多くの症例は術後数時間で抜管可能であり, 手術室で抜管可能な症例も散見された. レミフェンタニルは, 半減期が短く, 長時間使用しても蓄積がないことから, 手術中高いオピオイド濃度を維持しつつ早期抜管を目指した麻酔にとって有用なオピオイドである. レミフェンタニルが使用可能になったので, 手術室内での抜管を目指した麻酔管理を開始した. 麻酔方法の概略を紹介するとともに成績を検討した. 「方法」A. 対象 平成19年1月29日から4月末までの間に本院で実施し麻酔承諾書によりデータの研究使用の承諾が得られた心臓血管手術24例(男性11名/女性13名)を対象にした. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Remifentanil, fast-track anesthesia, extubation in the operation room |
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| English |
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| Title | Fast-Track Anesthesia Using Remifentanil Aimed for Tracheal Extubation in the Operation Room after Cardiovascular Surgery |
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| Subtitle | |
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| Authors | Masashi Nakagawa*, Kyoko Naitou*, Yoshiroh Kaminoh** |
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| Authors(kana) | |
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| Organization | *Department of Anesthesia, Social Insurance Kinan Hospital, **Department of Anesthesia, Hyogo College of Medicine |
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| Journal | Circulation Control |
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| Volume | 29 |
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| Number | 1 |
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| Page | 71-75 |
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| Year/Month | 2008/5 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Many kinds of anesthetic regimens are employed for fast-track cardiovascular surgery. We introduce our fast-track anesthesia method using remifentanil aimed for tracheal extubation in the operation room after cardiovascular surgery. Anesthesia was induced and maintained by target controlled infusion of propofol (in cases using cardiopulmonary bypass (CPB)) or sevoflurane (in cases not using CPB) with remifentanil infusion 0.3mcg/kg/min. Intravenous fentanyl infusion 0.5μg/kg/hr was started at about 2 hours before the end of surgery for postoperative analgesia. After the surgery, patients were awaken and extubated if chest X-ray didn't show any abnormal signs. Tracheal extubation in the operation room was achieved 58.3% of patients, and no severe complication was observed. Compared with having been possible for the operating room extubation as for 76.5% of cardiac surgery, the vascular surgery was able to do the operating room extubation only 14.3% (p＝0.005). However, when the cases which were able to carry out the extubation was included within 4 hours after ICU entering, the extubation was possible for 83.3% of total cases. Thus, this anesthetic method with remifentanil could be used as one of regimens for fast-track cardiovascular anesthesia. |
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| Practice | Basic medicine |
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| Keywords | Remifentanil, fast-track anesthesia, extubation in the operation room |
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