内視鏡下鼻内手術におけるエピネフリン加コカイン麻酔の安全性と有効性  [in Japanese] EFFICACY AND COMPLICATIONS OF TOPICAL COCAINE ANESTHESIA IN FUNCTIONAL ENDOSCOPIC SINUS SURGERY  [in Japanese]

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Abstract

成人178例に対し, 塩酸コカイン200mgとエピネフリン1mgを含んだガーゼタンポンによる表面麻酔下に内視鏡下鼻内手術を行い, 術前および術中の中枢症状, 脈拍, 血圧などの全身症状と術中の出血量, 手術時間を検討した. コカイン麻酔に伴うショック, 妄言, 呼吸抑制などの中枢症状と血圧の変動はなかったが, 毎分20回以上の脈拍の増加を26例で認めたが, 硫酸アトロピンを用いなかった症例では少なかった. 術中出血量は対象群とは有意差はなかったが, 手術時間は有意にコカイン使用群で短かった. コカインは200mg用いて安全であり, 粘膜微小血管からの滲出性出血を抑制することで, 手術時間を短縮すると思われた.

A 4% cocaine (total dose; 200mg) solution with 1mg epinephrine was used as a topical anesthetic for 178 cases undergoing functional endoscopic sinus surgery. Complications were investigated before and during surgery. Bleeding amount and operative duration were compared between patients with and without topical cocaine application. Tachycardia (26 cases) was the only complication encountered in this study. Tachycardia occurred at a high incidence in cases which used atropine as a premedication. Total bleeding amount did no differ significantly between those with and without topical cocaine. However, minimum bleeding cases (less than 20ml) were found in the cocaine group more frequently than in the non-cocaine group. Operative durations of cases with cocaine anesthesia were significantly shorter than cases without cocaine anesthesia. Those findings suggest that cocaine is effective for prevention of bleeding from micro-vessels and/or mucosal oozing, whereas bleeding from macro-vessels was not controlled by topical cocaine application. Topical cocaine anesthesia produced no major complications, even at 200mg, in the presence of 1mg epinephrine and when atropine use was avoided.

Journal

  • Nippon Jibiinkoka Gakkai Kaiho

    Nippon Jibiinkoka Gakkai Kaiho 98(8), 1263-1269, 1995-08-20

    The Oto-Rhino-Laryngological Society of Japan, Inc.

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