Fukagawa D, Yamaguchi S, Hamaguchi S, Mishio M, Okuda Y, Kitajima T
First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi 321-0293.
Masui. 2001 Jan;50(1):53-5.
A 76-year-old woman with acute myocardial infarction underwent an emergency coronary artery bypass graft operation. She developed cardiac failure and sick sinus syndrome before the surgery because she was with cardioamyloidosis. Therefore, intra-aortic balloon pumping and the pacemaker were used to maintain the hemodynamics prior to the operation. Anesthesia was induced with midazolam 5 mg, morphine 30 mg and pancuronium 5 mg, and maintained with 0.3-0.5% isoflurane in 50% nitrous oxide and 50% oxygen. Morphine 10 mg was also injected during the surgery, and the total dose of morphine 40 mg was administered. The pacemaker at 80 bpm was inserted and mexiletine 0.5 mg.kg-1.h-1 was given to prevent ventricular arrhythmias at weaning from cardio-pulmonary bypass. The surgical operation was successfully performed and the postoperative course was uneventful. A combination of light inhalation anesthesia with narcotics may be a choice for anesthetic management of patients with cardioamyloidosis as this method has less influence on hemodynamics.
一名76岁急性心肌梗死女性接受了急诊冠状动脉旁路移植手术。由于患有心脏淀粉样变性，她在手术前出现了心力衰竭和病态窦房结综合征。因此，在手术前使用主动脉内球囊反搏和起搏器来维持血流动力学。诱导麻醉使用咪达唑仑5毫克、吗啡30毫克和泮库溴铵5毫克，并用50%氧化亚氮和50%氧气混合的0.3 - 0.5%异氟醚维持麻醉。手术期间还注射了吗啡10毫克，吗啡总剂量达40毫克。植入了每分钟80次的起搏器，并给予美西律0.5毫克·千克⁻¹·小时⁻¹以预防体外循环撤机时的室性心律失常。手术成功完成，术后过程顺利。对于心脏淀粉样变性患者的麻醉管理，轻度吸入麻醉与麻醉性镇痛药联合使用可能是一种选择，因为这种方法对血流动力学的影响较小。
