不穏状態の鎮静に難渋した急性大動脈解離症例に対するdexmedetomidineの使用経験

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  • フオン ジョウタイ ノ チンセイ ニ ナンジュウシタ キュウセイ ダイドウミャク カイリ ショウレイ ニ タイスル dexmedetomidine ノ シヨウ ケイケン
  • Dexmedetomidine Used for Acute Aortic Dissection Associated with Severe Intractable Restlessness

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A 63-year-old male patient was hospitalized for acute aortic dissection (Stanford type A). CT examination revealed a dissection from the ascending aorta to the level of the renal artery. The false lumen was completely thrombosed to the level of diaphragm. No ulcer-like projection, enlarged aortic diameter, aortic valve regurgitation, or abnormal electrocardiogram were observed. The onset of the dissection was likely a couple of days before admission based on his medical history. He was transferred to the ICU and treated for pain and hypertension with nicardipine, according to the guidelines for treatment of the chronic phase aortic dissection. He developed severe restlessness and delirium during the night. Sedation with haloperidol failed and his blood pressure increased. We administered dexmedetomidine (DEX), an a adrenergic agonist, to avoid the respiratory depression of high-dose sedatives. No respiratory depression was observed and his hemodynamics were stabilized. The patient was sedated to Ramsay score 3 to 4, similar to normal sleep, and his pain was controlled. We believe that DEX can be effective for sedation and pain relief in the acute phase of aortic dissection.

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