Imanaka Norie, Nakasuji Masato, Nomura Masataka, Higuchi Mariko, Nakamura Mitsuyo, Tanaka Masuji, Kawashima Hiroko
Department of Anesthesiology, Kansai Denryoku Hospital, Osaka 553-0003.
Masui. 2009 May;58(5):652-4.
A 75-year-old man underwent elective posterior lumbar interbody fusion due to canal stenosis. Anesthesia was induced with fentanyl 100 microg, propofol 65 mg (0.95 mg x kg(-1)) and vecronium 7 mg. Bag and mask ventilation was easy and end-tidal sevoflurane reached 3% but arterial blood pressure (ABP) and heart rate (HR) increased to 180-200/90-110 mmHg and 90-110 beats x min(-1) respectively. Additional fentanyl 100 microg and propofol 70 mg were not effective. N2O was started and fentanyl 50 microg and landiolol 5 mg were administerd. Twenty-five minutes after initiation of anesthesia, ABP and HR decreased to 123/76 mmHg and 83 beats x min(-1), respectively. When right ureteral dilatation was undertaken due to obstruction on POD 7, thiamylal 300 mg for anesthetic induction did not increase ABP and HR. Hypertension with tachycardia during induction of general anesthesia can be usually caused by pain, hypoventilation, intracranial hemorrhage and myocardial ischemia etc but all of them were denied in this clinical course. Previous reports had shown that a small amount of propofol itself induced vasoconstriction and we concluded that a low dose of propofol to avoid hypotension during induction could cause hypertension with tachycardia.
一名75岁男性因椎管狭窄接受了择期后路腰椎椎间融合术。麻醉诱导采用100微克芬太尼、65毫克丙泊酚（0.95毫克/千克）和7毫克维库溴铵。面罩通气顺畅，呼气末七氟醚浓度达3%，但动脉血压（ABP）和心率（HR）分别升至180 - 200/90 - 110毫米汞柱和90 - 110次/分钟。追加100微克芬太尼和70毫克丙泊酚无效。开始使用氧化亚氮，并给予50微克芬太尼和5毫克兰地洛尔。麻醉开始25分钟后，ABP和HR分别降至123/76毫米汞柱和83次/分钟。术后第7天因输尿管梗阻进行右侧输尿管扩张时，300毫克硫喷妥钠用于麻醉诱导未使ABP和HR升高。全身麻醉诱导期间的高血压伴心动过速通常可由疼痛、通气不足、颅内出血和心肌缺血等引起，但在本临床过程中均排除了这些因素。既往报道显示，少量丙泊酚本身可诱发血管收缩，我们得出结论，为避免诱导期间低血压而使用低剂量丙泊酚可导致高血压伴心动过速。
