Hori Yasuo, Yamama Yoshihiro, Yagi Masami, Nakatani Keiji
Masui. 2016 Oct;65(10):1040-1042.
A 31-year-old primigravida diagnosed with moyamo- ya disease at age 27, underwent an urgent cesarean section at 37 weeks of gestation. At age 27 the patient had a superficial temporal artery-middle cerebral artery bypass operation, but the blood flow was not enough. Because she had serious anxiety neurosis and could not endure the strain of vaginal delivery or spi- nal anesthesia, general anesthesia was selected. Anesthesia was induced with thiopental, remifentanil and rocuronium, and was maintained with sevoflurane in air oxygen mixture before delivery. After delivery, anesthesia was maintained with propofol and remifent- anil. Hypertension caused by tracheal intubation was successfully prevented by remifentanil. The cesarean delivery was uneventful and a neonate was delivered with Apgar scores of 3 and 9 at 1 and 5 min, respec- tively. No adverse symptoms occurred. Both she and the neonate were discharged without adverse events. Remifentanil was effective for treating perioperative hypertension undergoing caesarean delivery in a patient with moyamoya disease.
一名31岁初产妇，27岁时被诊断为烟雾病，在妊娠37周时接受了紧急剖宫产手术。患者27岁时曾行颞浅动脉-大脑中动脉搭桥手术，但血流量不足。由于她患有严重的焦虑症，无法承受阴道分娩或脊髓麻醉的压力，因此选择了全身麻醉。麻醉诱导使用硫喷妥钠、瑞芬太尼和罗库溴铵，分娩前用七氟醚在空气-氧气混合气体中维持麻醉。分娩后，用丙泊酚和瑞芬太尼维持麻醉。瑞芬太尼成功预防了气管插管引起的高血压。剖宫产手术顺利，新生儿出生后1分钟和5分钟的阿氏评分分别为3分和9分。未出现不良症状。她和新生儿均顺利出院，无不良事件发生。瑞芬太尼对烟雾病患者剖宫产围手术期高血压的治疗有效。
