慢性膿胸に対する胸郭形成術の麻酔管理上の問題について : 6例の経験から Anesthetic Management in Thoracoplasty for Chronic Empyema

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抄録

慢性膿胸に対し胸郭形成術が施行された6例の麻酔管理を検討した。全例に呼吸機能障害を認めた。麻酔はフェンタニル,チオペンタールで導入し,酸素-空気-イソフルランと持続硬膜外麻酔で維持した。全例Broncho-Cath®を挿管し,1例で分離肺換気を施行した。重篤な低酸素,高二酸化炭素血症は認めなかった。出血量は平均628mlで5例で輸血を行った。手術操作で心圧迫が生じ,全例にドパミンを投与した。持続する低血圧や不整脈は認めなかった。7本の肋骨を切除した1例は過度の胸腔容積の縮小で肺動脈圧の高値と,呼吸困難を認め抜管できなかった。胸郭形成術では出血,心圧迫への対処と,胸腔容積縮小による心,肺の拡張障害が生じることに注意が必要であった。

We studied the anesthetic management of six patients with chronic empyema who underwent thoracoplasty. All cases presented with severe chronic respiratory failure due to sequelae of pulmonary tuberculosis and empyema. Anesthesia was induced with fentanyl and thiopental, and was maintained with isoflurane in oxygen/air and an epidural block using mepivacaine. The trachea was intubated with a double-lumen endobronchial tube. Mean hemorrhage was 628ml, and blood tranfusions were performed in five cases. Transient hypotension was triggered by the operation, but severe hypoxia and hepercarpnia, persitent hypotension, and lethal arrhythmia were never encountered. In one case, after thoracoplasty with the resection of seven ribs was completed, elevation of the pulmonary arterial pressure and a low cardiac index assessed by a pulmonary catheter occurred. These developed because the excessive thoracic deformity deteriorated the diastolic cardiac function. His trachea could not be extubated due to dyspnea. For better anesthetic management, we should pay careful attention to the deterioration of diastolic cardiac function and respiratory function in addition to massive bleeding.

収録刊行物

  • 日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia

    日本臨床麻酔学会誌 = The Journal of Japan Society for Clinical Anesthesia 22(9), 352-356, 2002-11-15

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

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各種コード

  • NII論文ID(NAID)
    10010155461
  • NII書誌ID(NCID)
    AN00330159
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    02854945
  • データ提供元
    CJP書誌  J-STAGE 
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