循環制御
Print ISSN : 0389-1844
症例
術前より高度の貧血がみられた輸血拒否患者の緊急手術の麻酔管理
大迫 正一林 行雄安江 雄一松山 恭悠田村 岳士真下 節
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2011 年 32 巻 1 号 p. 22-25

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We reported anesthetic management of a parturient of Jehova’s Witness with severe anemia(Hb: 5.8g/dl), undergoing emergent hysterectomy. Her massive bleeding continued following dilatation and curettage for missed abortion. Anesthesia was induced with propofol, fentanyl and rocuronium and maintained with sevoflurane and remifentanil. Hypotension after induction of anesthesia was treated with volume loading with 5% albumin and repeated bolus injection of phenylephrine. Although continuous infusion of dopamine was given to maintain blood pressure after start of the operation, ST segment depression was noted in II, III and aVF. Then, dopamine was replaced by noradrenaline and thereafter, ST depression was alleviated. Considering the episode of ST depression and the value of Hb of 2.8g/dl at end of the operation, the patient was transported to ICU without extubation and under sedation with propofol to suppress the oxygen consumption. The patient was extubated on 10th postoperative day without any respiratory or neurological complications. The present case suggests that perioperative management to suppress the oxygen consumption may be a useful for a patient of Jehova’s Witness with severe anemia.

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© 2011 日本循環制御医学会
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