Furuya A, Matsukawa T, Ozaki M, Kumazawa T
Department of Anesthesia, Yamanashi Medical University, Japan.
J Clin Anesth. 1998 May;10(3):242-5. doi: 10.1016/s0952-8180(98)00015-4.
We report a case of general anesthesia in a 25 year-old female patient with moyamoya disease who presented for cesarean section. General anesthesia was induced with propofol 100 mg, succinylcholine 50 mg, and nicardipine 1 mg intravenously (i.v.), and maintained with 60% nitrous oxide in oxygen. Just after the clamp of the umbilical cord, propofol 10 mg/kg/hr following propofol 50 mg pentazocine 15 mg vecuronium 8 mg, and methylergometrine maleate 0.2 mg were given i.v. The rate of infusion of propofol was reduced to 8 mg/kg/hr 10 minutes after the clamp and reduced to 6 mg/kg/hr 20 minutes after the clamp. Additional pentazocine 15 mg was given i.v. Blood pressure was maintained between 110 and 145 systolic, and 50 and 85 diastolic mmHg, and end-tidal carbon dioxide was between 34 and 36 mmHg. No postoperative deterioration of the patient's neurologic findings occurred. For the anesthetic management of moyamoya disease patients, especially in delivery, it is important to avoid hemodynamic changes and to maintain cerebral blood flow (CBF). We used propofol for hemodynamic stability and avoided hyperventilation so as to maintain CBF. We successfully managed the patient perioperatively.
我们报告了一例25岁患有烟雾病的女性患者行剖宫产术时的全身麻醉情况。静脉注射异丙酚100mg、琥珀酰胆碱50mg和尼卡地平1mg诱导全身麻醉，并用60%氧化亚氮-氧气维持麻醉。在钳夹脐带后，静脉注射异丙酚50mg、喷他佐辛15mg、维库溴铵8mg和马来酸甲基麦角新碱0.2mg，随后以10mg/kg/hr的速率输注异丙酚。钳夹后10分钟，异丙酚输注速率降至8mg/kg/hr，钳夹后20分钟降至6mg/kg/hr。静脉追加喷他佐辛15mg。收缩压维持在110至145mmHg之间，舒张压维持在50至85mmHg之间，呼气末二氧化碳分压维持在34至36mmHg之间。患者术后神经功能未出现恶化。对于烟雾病患者的麻醉管理，尤其是在分娩时，避免血流动力学变化和维持脑血流量（CBF）很重要。我们使用异丙酚来维持血流动力学稳定，并避免过度通气以维持CBF。我们成功地对该患者进行了围手术期管理。
