Otaka K, Sato M, Hori M, Suzuki M
Department of Anesthesiology, Nakadohri General Hospital, Akita.
Masui. 1993 Aug;42(8):1200-5.
Infantile periarteritis nodosa is a rare disease characterized by systemic obstructive arteritis involving coronary artery. This report is anesthetic experience of a 12-years-old boy with unstable angina secondary to infantile periarteritis nodosa, who underwent left ventricular aneurysmectomy and coronary artery bypass grafting. Anesthesia was induced with fentanyl, diazepam and enflurane, and transesophageal echocardiography (TEE) was used as a cardiac function monitor. The following two intraoperative crises occurred in succession: first, aggravation of myocardial ischemia followed by ventricular tachycardia, and second, sudden interruption of cardiopulmonary bypass due to blood coagulation in membrane oxygenator. In these situations, we could detect his critical situations promptly, because segmental wall-motion abnormality and global enlargement of both ventricles were observed with TEE before the onset of these crises. In these crises, we could treat him appropriately. Postoperative course was uneventful and he had no neurological deficit nor angina. We conclude that TEE is a powerful non-invasive monitor for early detection of cardiac dysfunction in heart surgery.
小儿结节性多动脉炎是一种罕见疾病，其特征为累及冠状动脉的系统性阻塞性动脉炎。本报告是关于一名12岁男孩的麻醉经验，该男孩因小儿结节性多动脉炎继发不稳定型心绞痛，接受了左心室室壁瘤切除术和冠状动脉旁路移植术。麻醉诱导采用芬太尼、地西泮和恩氟烷，并使用经食管超声心动图（TEE）作为心功能监测手段。术中相继发生了以下两次危急情况：首先是心肌缺血加重继而出现室性心动过速，其次是由于膜式氧合器内血液凝固导致体外循环突然中断。在这些情况下，我们能够及时察觉他的危急状况，因为在这些危急情况发生之前，通过TEE观察到节段性室壁运动异常和双心室整体扩大。在这些危急情况下，我们能够对他进行恰当治疗。术后过程平稳，他没有神经功能缺损也没有心绞痛症状。我们得出结论，TEE是心脏手术中早期发现心功能障碍的一种强大的非侵入性监测手段。
