Arai M, Takenaka T, Kato S
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara.
Masui. 1997 Jul;46(7):970-4.
The subject was a 73 year old man scheduled for resection of abdominal aortic aneurysm. The patient had a past history of myocardial infarction and his left ventricular ejection fraction was 21%. Anesthesia was maintained with thoracic epidural anesthesia combined with light general anesthesia using NLA technique. Phentolamine was infused for after-load reduction. We maintained the intravascular volume with infusion therapy and mild hemodilution was performed. As the result of these procedures, systemic vascular resistance decreased and cardiac index increased after the induction of anesthesia. Forrester classification was subset I at any point during the surgery. Hemodynamic changes were not significant after clamping and unclamping of the aorta. We conclude that successful anesthetic management of this patient was due to the epidural anesthesia and combined use of phentolamine as a vasodilator.
患者为一名73岁男性，计划行腹主动脉瘤切除术。该患者有心肌梗死病史，左心室射血分数为21%。采用胸段硬膜外麻醉联合使用NLA技术的浅全身麻醉维持麻醉。输注酚妥拉明以降低后负荷。我们通过输液治疗维持血管内容量，并进行了轻度血液稀释。由于这些措施，麻醉诱导后全身血管阻力降低，心脏指数增加。手术过程中任何时间点的Forrester分级均为I型。主动脉夹闭和松开后血流动力学变化不显著。我们得出结论，该患者麻醉管理成功归因于硬膜外麻醉以及联合使用酚妥拉明作为血管扩张剂。
