Nagashima Michio, Nagashima Kimimoto, Endo Akio, Takahata Osamu, Sengoku Kazufumi, Iwasaki Hiroshi
Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical College, 078-8510.
Masui. 2002 Dec;51(12):1349-51.
We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. After the delivery, propofol was administered at 3-5 mg.kg-1.hr-1. Except for temporary hypotension due to massive bleeding, systolic blood pressure was maintained between 100 and 120 mmHg. Arterial carbon dioxide tension was maintained at about 40 mmHg. Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.
我们报告了一名31岁患有烟雾病的女性患者的麻醉管理情况，该患者因前置胎盘行剖宫产术，采用全身麻醉联合硬膜外麻醉。首先使用10毫升2%利多卡因进行硬膜外麻醉。然后在手术开始前用200毫克硫喷妥钠和60毫克琥珀胆碱诱导全身麻醉，并以60%氧化亚氮-氧气混合气体维持麻醉。分娩后，以3 - 5毫克·千克⁻¹·小时⁻¹的速率输注丙泊酚。除了因大量出血导致的短暂性低血压外，收缩压维持在100至120毫米汞柱之间。动脉二氧化碳分压维持在约40毫米汞柱。还测量了颅内血流速度和局部氧饱和度以监测脑血流量。术后无疼痛，也无术后神经功能缺损。基于这些发现，得出结论：对于因前置胎盘行择期剖宫产术的烟雾病患者，全身麻醉联合硬膜外麻醉对围手术期管理是有效的。
