心拍動下冠動脈バイパス術（OPCAB）の麻酔
心拍動下冠動脈バイパス術（OPCAB）は心臓手術の中でも麻酔科医と心臓血管外科医の密接な連携を必要とし，血行動態・不整脈のコントロール，体位や換気法などの術中管理をする上では麻酔科医の役割が重要である．麻酔科医はハートチームの重要性を理解し，患者の病態を把握して危険因子を的確に評価しなければならない．さらに手術の手順を把握し，そのとき起こりうるイベントを予期し，術中不整脈や吻合中に起こる循環動態の変動に対する対処法，心筋虚血への対応を熟知していなければならない．また，術中のみならず術後を見越した呼吸・循環・代謝管理および体温管理や疼痛管理も重要である．...
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| Published in | 日本臨床麻酔学会誌 Vol. 34; no. 3; pp. 338 - 344 |
|---|---|
| Main Authors | , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.34.338 |
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| Abstract | 心拍動下冠動脈バイパス術（OPCAB）は心臓手術の中でも麻酔科医と心臓血管外科医の密接な連携を必要とし，血行動態・不整脈のコントロール，体位や換気法などの術中管理をする上では麻酔科医の役割が重要である．麻酔科医はハートチームの重要性を理解し，患者の病態を把握して危険因子を的確に評価しなければならない．さらに手術の手順を把握し，そのとき起こりうるイベントを予期し，術中不整脈や吻合中に起こる循環動態の変動に対する対処法，心筋虚血への対応を熟知していなければならない．また，術中のみならず術後を見越した呼吸・循環・代謝管理および体温管理や疼痛管理も重要である． |
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| AbstractList | 心拍動下冠動脈バイパス術（OPCAB）は心臓手術の中でも麻酔科医と心臓血管外科医の密接な連携を必要とし，血行動態・不整脈のコントロール，体位や換気法などの術中管理をする上では麻酔科医の役割が重要である．麻酔科医はハートチームの重要性を理解し，患者の病態を把握して危険因子を的確に評価しなければならない．さらに手術の手順を把握し，そのとき起こりうるイベントを予期し，術中不整脈や吻合中に起こる循環動態の変動に対する対処法，心筋虚血への対応を熟知していなければならない．また，術中のみならず術後を見越した呼吸・循環・代謝管理および体温管理や疼痛管理も重要である． |
| Author | 小林, 隆史 鈴木, 健二 |
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| Copyright | 2014 日本臨床麻酔学会 |
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| References | 2) Mukherjee D, Ahmed K, Baig K, et al.: Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis. Ann Thorac Surg 91: 630-639, 2011 13) Fleisher LA, Beckman JA, Brown KA, et al.: ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: e418-e499, 2007 7) Murry CE, Jennings RB, Reimer KA: Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74: 1124-1136, 1986 3) Omae T, Kakihana Y, Mastunaga A, et al.: Hemodynamic changes during off-pump coronary artery bypass anastomosis in patients with coexisting mitral regurgitation: improvement with milrinone. Anesth Analg 101: 2-8, 2005 9) IONA Study Group: Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet 359: 1269-1275, 2002 6) Ishikawa K, Kobayashi T, Wakimoto M, et al.: Perioperative administration of nicorandil might compensate for the pharmacological preconditioning effect with isoflurane anesthesia: A prospective randomized clinical trial in off-pump coronary arterial bypass graft surgery. J Iwate Med Assoc 65: 75-85, 2013 5) 中村裕美：術前訪問における手術室看護師の看護実践に関する文献研究．日本手術看護学会誌 8：73-75，2012 4) 川村隆枝，門崎衛：総論 心臓麻酔・術中管理 a．成人(2)，心臓手術─周術期管理の実際─．川副浩平，佐野俊二，一色高明編．メジカルビュー社，東京，2003，92-103 14) Dorsa AG, Rossi AI, Thierer J, et al.: Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: feasibility, safety and predictors of when not to attempt it. J Cardiothorac Vasc Anesth 25: 431-436, 2011 8) Yellon DM, Alkhulaifi AM, Pugsley WB: Preconditioning the human myocardium. Lancet 342: 276-277, 1993 12) Bein B, Renner J, Caliebe D, et al.: The effects of interrupted or continuous administration of sevoflurane on preconditioning before cardio-pulmonary bypass in coronary artery surgery: comparison with continuous propofol. Anaesthesia 63: 1046-1055, 2008 10) Yamamoto S, Yamada T, Kotake Y, et al.: Cardioprotective effects of nicorandil in patients undergoing on-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 22: 548-553, 2008 1) Wijns W, Kolh P, Danchin N, et al.; Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS): Guidelines on myocardial revascularization. Eur Heart J 31: 2501-2555, 2010 11) Ito I, Hayashi Y, Kawai Y, et al.: Prophylactic effect of intravenous nicorandil on perioperative myocardial damage in patients undergoing off-pump coronary artery bypass surgery. J Cardiovasc Pharmacol 44: 501-506, 2004 |
| References_xml | – reference: 4) 川村隆枝，門崎衛：総論 心臓麻酔・術中管理 a．成人(2)，心臓手術─周術期管理の実際─．川副浩平，佐野俊二，一色高明編．メジカルビュー社，東京，2003，92-103 – reference: 10) Yamamoto S, Yamada T, Kotake Y, et al.: Cardioprotective effects of nicorandil in patients undergoing on-pump coronary artery bypass surgery. J Cardiothorac Vasc Anesth 22: 548-553, 2008 – reference: 11) Ito I, Hayashi Y, Kawai Y, et al.: Prophylactic effect of intravenous nicorandil on perioperative myocardial damage in patients undergoing off-pump coronary artery bypass surgery. J Cardiovasc Pharmacol 44: 501-506, 2004 – reference: 5) 中村裕美：術前訪問における手術室看護師の看護実践に関する文献研究．日本手術看護学会誌 8：73-75，2012 – reference: 3) Omae T, Kakihana Y, Mastunaga A, et al.: Hemodynamic changes during off-pump coronary artery bypass anastomosis in patients with coexisting mitral regurgitation: improvement with milrinone. Anesth Analg 101: 2-8, 2005 – reference: 6) Ishikawa K, Kobayashi T, Wakimoto M, et al.: Perioperative administration of nicorandil might compensate for the pharmacological preconditioning effect with isoflurane anesthesia: A prospective randomized clinical trial in off-pump coronary arterial bypass graft surgery. J Iwate Med Assoc 65: 75-85, 2013 – reference: 7) Murry CE, Jennings RB, Reimer KA: Preconditioning with ischemia: a delay of lethal cell injury in ischemic myocardium. Circulation 74: 1124-1136, 1986 – reference: 1) Wijns W, Kolh P, Danchin N, et al.; Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS): Guidelines on myocardial revascularization. Eur Heart J 31: 2501-2555, 2010 – reference: 12) Bein B, Renner J, Caliebe D, et al.: The effects of interrupted or continuous administration of sevoflurane on preconditioning before cardio-pulmonary bypass in coronary artery surgery: comparison with continuous propofol. Anaesthesia 63: 1046-1055, 2008 – reference: 14) Dorsa AG, Rossi AI, Thierer J, et al.: Immediate extubation after off-pump coronary artery bypass graft surgery in 1,196 consecutive patients: feasibility, safety and predictors of when not to attempt it. J Cardiothorac Vasc Anesth 25: 431-436, 2011 – reference: 2) Mukherjee D, Ahmed K, Baig K, et al.: Conversion and safety in off-pump coronary artery bypass: a system failure that needs re-emphasis. Ann Thorac Surg 91: 630-639, 2011 – reference: 9) IONA Study Group: Effect of nicorandil on coronary events in patients with stable angina: the Impact Of Nicorandil in Angina (IONA) randomised trial. Lancet 359: 1269-1275, 2002 – reference: 8) Yellon DM, Alkhulaifi AM, Pugsley WB: Preconditioning the human myocardium. Lancet 342: 276-277, 1993 – reference: 13) Fleisher LA, Beckman JA, Brown KA, et al.: ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation 116: e418-e499, 2007 |
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| Title | 心拍動下冠動脈バイパス術（OPCAB）の麻酔 |
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