Hayashi M, Terai T, Nishikawa K, Yukioka H, Fujimori M
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School.
Masui. 1991 Apr;40(4):622-6.
A 23-year-old woman with Marfan's syndrome was scheduled for Cesarean section at 31 week gestation because of progressive aortic dissection. Since she had undergone two surgical corrections for scoliosis (Harrington rod instrumentation) 5 and 12 years ago, we selected general anesthesia. She had been taking diltiazem and propranolol for hypertension and tachycardia. Anesthesia was induced with thiopental 75 mg iv followed by O2-N2O-enflurane (4%) by face mask. Following iv administration of vecuronium 4 mg and tracheal injection of 4% lidocaine 120 mg, the trachea was intubated without a significant hemodynamic change. Anesthesia was maintained with O2-N2O-enflurane (0.5-1.5%) before delivery. Following delivery, enflurane was discontinued and small doses of fentanyl iv (total 0.2 mg) were given with iv infusion of nitroglycerin (0.2-0.5 micrograms.kg-1.min-1) during surgery. Bleeding after delivery was controllable by iv infusion of oxytocin. The Apgar score was good (9 at 1 min and 10 at 5 min respectively). Post-operative course was uneventful. Therapeutic abortion or Cesarean section should be performed as soon as possible in a patient with dissecting aortic aneurysm because of increasing risk of aneurysm rupture during pregnancy. During the surgery, minimal hemodynamic changes are required to prevent the rupture.
一名患有马凡氏综合征的23岁女性，因进行性主动脉夹层，计划在妊娠31周时行剖宫产术。由于她在5年前和12年前曾因脊柱侧弯接受过两次手术矫正（哈灵顿棒内固定术），我们选择了全身麻醉。她一直在服用地尔硫䓬和普萘洛尔来控制高血压和心动过速。静脉注射硫喷妥钠75mg诱导麻醉，随后面罩吸入氧气 - 氧化亚氮 - 安氟醚（4%）。静脉注射维库溴铵4mg并气管内注射4%利多卡因120mg后，气管插管，血流动力学无明显变化。分娩前用氧气 - 氧化亚氮 - 安氟醚（0.5 - 1.5%）维持麻醉。分娩后，停用安氟醚，手术期间静脉注射小剂量芬太尼（总量0.2mg）并静脉输注硝酸甘油（0.2 - 0.5微克·千克⁻¹·分钟⁻¹）。分娩后出血可通过静脉注射缩宫素控制。阿氏评分良好（1分钟时为9分，5分钟时为10分）。术后过程顺利。由于妊娠期间主动脉瘤破裂风险增加，对于主动脉夹层瘤患者应尽早进行治疗性流产或剖宫产术。手术期间，需要最小的血流动力学变化以防止破裂。
