複雑な大動脈外科手術における神経軸麻酔:高リスク患者の実現可能な選択肢
Raed Sami Altowairki1, Muzackir Abubaker Mohammed1, Khalid Nasser Bin Ghali1
1Department of Anesthesiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Saudi journal of anaesthesia
|February 19, 2026
まとめ
胸外麻酔 (Toracic epidural anesthesia,TEA) は,外周動脈疾患を有する高リスク患者の複雑な大動脈再建のために,全身麻酔 (GA) に安全な代替手段を提供します. このアプローチは,心臓のストレスを軽減し,アウトカムを改善することができます.
科学分野:
- 血管外科 血管外科
- アネステシオロジー アネステシオロジー
- 心臓病学 心臓病学
背景:
- アオートイリアック閉塞性疾患 (AIOD) は,しばしば全身麻酔 (GA) による複雑な血管再建を必要とします.
- GAは,エジェクション分数の減少を含む,進行した心疾患の患者に重大なリスクをもたらす.
- 高リスク患者の周周回動脈疾患の管理には,麻酔を慎重に考慮する必要があります.
研究 の 目的:
- 重度の心不全を有する患者の胸部外周麻酔 (TEA) を使用した広範なAIOD修復の症例を報告する.
- 高リスク血管外科手術におけるGAの代替としてTEAの実現可能性と安全性を評価する.
主な方法:
- 極端な肢体イシュケミア,広範囲のAIOD,重度の心不全性疾患を患っている51歳の男性に,大動脈双門バイパス,大動脈内関節切除,双門内関節切除,および深部整形手術が行われました.
- 手術は胸部外周麻酔 (TEA) と手術中の鎮静下で行われました.
- 血液動力学的管理には,低血圧に対するノレピネフリン注入,手術後の鎮痛には, epidural ropivacaine-fentanyl注入およびマルチモダル薬を使用した.
主要な成果:
- 胸部外周麻酔 (TEA) は,効果的な外科麻酔,血液動力学的安定性,および優れた疼痛緩和を提供しました.
- 患者は,ICUのモニタリングが最小限にされ,痛みがよくコントロールされた状態で,安定した術後の経過を経験しました.
- 麻酔に関連した主要な手術内および手術後の合併症は報告されていません.
結論:
- 胸外麻酔 (Toracic epidural anesthesia,TEA) は,広範な大動脈の手術を受ける高リスクの患者にとって,全身麻酔 (GA) の実現可能で安全な代替手段です.
- TEAは,心臓のストレスを軽減し,疼痛管理を強化し,特定の血管外科手術患者の肺合併症を軽減することができます.
- 高リスクの血管外科手術における地域麻酔技術のより広範な適用を支援するために,さらなる研究が推奨されています.
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