| Japanese |
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| Title | 術前より高度の貧血がみられた輸血拒否患者の緊急手術の麻酔管理 |
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| Subtitle | 症例 |
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| Authors | 大迫正一, 林行雄, 安江雄一, 松山恭悠, 田村岳士, 真下節 |
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| Organization | 大阪大学医学部附属病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 32 |
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| Number | 1 |
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| Page | 22-25 |
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| Year/Month | 2011/4 |
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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」信仰上の理由による輸血拒否患者が大量出血により重度の貧血を呈した際, その周術期管理は時に危機的となることが想像できる. 今回, 信仰上の理由により輸血を拒否した患者が, 子宮内膜掻爬術に伴う大量出血のため, 救命目的で子宮全摘術を緊急に施行せざるを得なくなり, その麻酔管理を経験したので報告する. 「症例」患者は36歳女性. 身長158cm, 非妊時体重55.4kg. 2度の帝王切開の既往歴があった. 妊娠第6週に当院産婦人科を受診し, 稽留流産が疑われたため, 子宮内膜掻爬術が予定された. その際, 患者は信仰上の理由により輸血を拒否していたため, 当院様式による輸血拒否の免責証書に対して, 患者本人および配偶者の署名を得た. ただし, アルブミン, 凝固因子製剤の投与は拒否しないことも同時に確認された. 子宮内膜掻爬術に伴う出血量が1,450mlに達し, 掻爬術終了後も出血が持続した. 出血の持続に伴い, 血圧が60/30mmHgまで低下した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | anemia, Jehovah's Witness |
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| English |
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| Title | Anesthetic Management of a Jehova's Witness with Severe Anemia Undergoing Emergent Hysterectomy |
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| Authors | Seiichi Osako, Yukio Hayashi, Yuichi Yasue, Yasuhiro Matsuyama, Takeshi Tamura, Takashi Mashimo |
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| Organization | Department of Anesthesiology, Osaka University Hospital |
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| Journal | Circulation Control |
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| Volume | 32 |
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| Number | 1 |
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| Page | 22-25 |
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| Year/Month | 2011/4 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control in Medicine |
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| Abstract | We reported anesthetic management of a parturient of Jehova's Witness with severe anemia (Hb: 5.8g/dl), undergoing emergent hysterectomy. Her massive bleeding continued following dilatation and curettage for missed abortion. Anesthesia was induced with propofol, fentanyl and rocuronium and maintained with sevoflurane and remifentanil. Hypotension after induction of anesthesia was treated with volume loading with 5% albumin and repeated bolus injection of phenylephrine. Although continuous infusion of dopamine was given to maintain blood pressure after start of the operation, ST segment depression was noted in II, III and aVF. Then, dopamine was replaced by noradrenaline and thereafter, ST depression was alleviated. Considering the episode of ST depression and the value of Hb of 2.8g/dl at end of the operation, the patient was transported to ICU without extubation and under sedation with propofol to suppress the oxygen consumption. The patient was extubated on 10th postoperative day without any respiratory or neurological complications. The present case suggests that perioperative management to suppress the oxygen consumption may be a useful for a patient of Jehova's Witness with severe anemia. |
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| Practice | Basic medicine |
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| Keywords | anemia, Jehovah's Witness |
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