鎌状赤血球症の有痛性クリーゼに対する治療経験─オピオイドとケタミン投与による疼痛管理─  [in Japanese] Low Dose Ketamine-midazolam Regimen as an Adjuvant Therapy for Painful Vaso-occlusive Crisis Refractory to Opioids in a Patient with Sickle Cell Disease:A Case Report  [in Japanese]

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Abstract

<p>鎌状赤血球症(sickle cell disease:SCD)の有痛性クリーゼに対する疼痛管理を経験した.症例は33歳,黒人男性.全身痛と発熱を主訴に救急搬送され,SCD有痛性クリーゼと診断,同日入院した.抗菌薬投与と補液による全身管理および強オピオイド投与による疼痛管理を開始したが,疼痛コントロールは不良だった.オピオイドと並行してケタミンとミダゾラムを投与したところ痛みは軽減した.ケタミンはオピオイドと併用することでSCD有痛性クリーゼの痛みを軽減させ,オピオイド投与量を減少させる有用な鎮痛補助薬と成り得る.</p>

<p>A 33-year-old man presented to our emergency department with vaso-occlusive crisis after few days of worsening shoulder, back, and hip pain refractory to oral opioids. He was admitted to the intensive care unit with severe painful sickle cell crisis with no response to high doses of IV morphine and adjuvant analgesics. A ketamine(10 mg bolus and 0.2 mg/kg/h infusion)-midazolam(2 mg bolus and 1mg/h infusion)regimen was administered along with the opioids, after which the patient felt comfortable for the first time since admission. Ketamine was discontinued on day 9 of hospitalization and the patient was discharged on day 12. He could transit to oral opioids compatible with discharge. Low dose ketamine midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sickle cell disease with severe painful crisis.</p>

Journal

  • THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA

    THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA 39(4), 365-370, 2019

    THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA

Codes

  • NII Article ID (NAID)
    130007686803
  • Text Lang
    JPN
  • ISSN
    0285-4945
  • Data Source
    J-STAGE 
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