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2000年の当院麻酔科管理症例のぅち,20歳未満と心臓大血管手術症例を除いた3,432例を対象とし,高血圧の頻度,術前治療の有無と方法,周術期血圧の関連を検討した.高血圧合併頻度は18%,このうち術前治療群は66%であった.治療群の入院時血圧は収縮期140±18mmHg,拡張期80±13mmHgで,両値とも非治療群より有意に低かった.臓器障害/心血管病合併率は治療群が非治療群より有意に高かった.全身麻酔症例では,降圧薬1剤投与群は非治療群より手術室入室時拡張期血圧が有意に低かったが,術中血圧変動や降圧薬投与には差はなかった.高血圧患者の麻酔では,術前治療のいかんにかかわらず,その術中血圧管理に細心の注意を要すると考えられた.

パラチオンを服毒した慢性透析患者において,持続的血液透析(continuous venovenous hemodialysis,CVVHD)下におけるpralidoxime(2-PAM)薬物動態を検討しえた。症例は67歳の男性で,週3回の血液透析を受けていた。自殺企図にてパラチオン15mlを服毒し,アトロピン,2-PAMを併用した心肺蘇生に成功の後,ICUに収容した。筋攣縮や縮瞳などの症状の改善を目安にCVVHD施行下で2-PAM0.1g・hr-1を約20時間持続投与し,血中ならびに透析廃液中の2-PAM濃度を経時的に測定してCVVHDによる排泄と薬物動態を検討した。その結果,持続投与中の血中濃度は22～23mg・ml-1と高値であり,CVVHDによるクリアランスは約8.1ml・min-1と極めて小さく,半減期が健常人の1.1時間に比べ40時間と著明に延長することが判明した。有機リン中毒に対しCVVHD施行下で2-PAMを投与する場合,体外排泄の遅延による過剰投与に十分注意する必要があると考えられた。

Transesophageal echocardiography is an invaluable hemodynamic monitoring modality. Extended and anatomically based evaluation of cardiac function with transesophageal echocardiography is essential to prompt and accurate decision-making in anesthetic management during cardiac surgery. Fractional shortening and fractional area changes are indices widely used to assess the global systolic performance of the left ventricle. Monitoring regional function using semi-quantitative scoring has been demonstrated to be a more sensitive indicator of myocardial ischemia. Assessment of left ventricular diastolic function should be performed in a systematic way, measuring transmitral flow, pulmonary venous flow, transmitral color M-mode flow propagation velocity, and mitral annulus tissue Doppler imaging. The unique anatomical features of the right ventricle make echocardiographic evaluation complicated and therefore less frequently employed. Right ventricular fractional area change, tricuspid annular plane systolic excursion, maximal systolic tricuspid annular velocity with tissue Doppler imaging, and myocardial performance index are indices successfully incorporated into intraoperative right ventricular assessment. Left ventricular outflow tract obstruction with systolic anterior motion of the mitral valve may develop after cardiac procedures. Transesophageal echocardiography plays a central role in prevention as well as diagnosis of systolic anterior motion. Transesophageal echocardiography is extremely useful not only for detecting and locating intracardiac air, but also for guiding and evaluating the procedures to remove air. Air is likely to persist in the right and left superior pulmonary vein, left ventricular apex, left atrium, right coronary sinus of Valsalva, and ascending aorta. Accurate evaluation of cardiac function depends on performing TEE examination properly and obtaining optimal images.

We have compared the rapidity and quality of recovery after sevoflurane anaesthesia with those after halothane anaesthesia. Thirty unpremedicated paediatric outpatients undergoing pulsed-dye laser therapy for port-wine stains were allocated randomly to receive either halothane or sevoflurane anaesthesia. Each group received 60% nitrous oxide and 1.0-1.5 MAC of volatile agent in oxygen for approximately 40 min. Patients receiving sevoflurane exhibited more rapid emergence and a significantly shorter postoperative recovery time compared with those receiving halothane. No major adverse effects were encountered in each group. These results suggest that sevoflurane anaesthesia is preferable to halothane anaesthesia for paediatric ambulatory patients.

ASPIRATION during feeding in patients with tracheostomies and whose lungs are mechanically ventilated is a frequent and serious problem that can result in airway obstruction and pulmonary infection. 1-3 We describe a patient with a cervical cord transection suffering from frequent aspiration during feeding. Fiberoptic examination revealed a disruption of the glottic closure reflex. Continuous insufflation of oxygen into the subglottic airway using a speaking tracheostomy tube restored competent glottic closure reflex and was effective in preventing aspiration.

Twelve patients with mechanical infertility in the in vitro fertilization program were studied. Seven of them received halothane anaesthesia and the other five received neuroleptanaesthesia. Higher plasma prolactin levels and lower plasma progesterone levels were observed in the neuroleptanaesthesia group than in the halothane group during and after transvaginal ultrasound-guided oocyte pick-up. Plasma adrenocorticotropic hormone and cortisol levels of the patients suggested that surgical stress was minimal in both groups. It is likely that droperidol and fentanyl, both used in neuroleptanaesthesia, were responsible for the hyperprolactinaemia which was followed by inhibition of progesterone production. These agents, therefore, are not recommended as anaesthetic agents for transvaginal ultrasound-guided oocyte pick-up.