We examined the effects of α₂-adrenergic agonist, dexmedetomidine(DEX), on tetrodotoxin-resistant (TTX-r) Na⁺ currents using small-sized dorsal root ganglion(DRG) cells of the rats. Whole cell patch-clamp configuration was used. After control Na⁺ current was recorded, DEX was added to the extracellular solution. Yohimbine and prazosin were used to differentiate the contribution of α₂-adrenergic receptor from that of α₁-adrenergic receptor. The peak TTX-r Na⁺ currents were significantly and dose dependently inhibited by DEX(p<0.05). Yohimbine attenuated the suppressive effects of DEX on TTX-r Na⁺ currents, while prazosin did not alter the effects of DEX. Thus, DEX inhibited TTX-r Na⁺ currents by way of α₂-adrenergic receptors but not α₁-adrenergic receptors. Therefore, it is suggested that DEX has an inhibitory effect on TTX-r Na⁺ channels through α₂-adrenergic receptors.

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Stanford A型急性大動脈解離(A型急性解離)に破裂性腹部大動脈瘤を合併した症例の緊急の一期的同時手術を経験した．症例は75歳男性で，A型急性解離を発症したが放置，2日後に腹部大動脈瘤が破裂し，ショック症状に陥り当院入院となった．来院時には，両側足趾に壊死も認めた．手術は超低体温循環停止下に上行大動脈と腹部大動脈を同時に置換した．体外循環からの離脱や止血は共に良好で，集中治療室に帰室した．第1病日には右下腿の壊死が進行し，切断した．第2病日には左下腿の壊死が進行し，切断を考慮したが家族の承諾が得られず，多臓器不全より死亡した．緊急の重複大動脈手術に対する手術戦略上の問題や過大侵襲に伴う周術期の合併症対策(特に虚血肢対策)などの問題があり報告する．

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We report successful anesthetic management of a patient with severe congestive heart failure(CHF). A 77-year-old male underwent total gastrectomy for the gastric cancer. He had been diagnosed of severe CHF like as dilated cardiomyopathy previously. The cardiac ultrasonography showed the enlarged left ventricle(LV) with LV diastolic internal dimension of 62mm and LV ejection fraction of 20%. Dopamine and colforsin daropate hydrochloride were administered to support cardiovascular performance. The cardiac index monitored by Hemosonic^TM was maintained over 3.0 liters/min/m². The patient was weaned from the respirator 5 days after surgery and recovered to discharge by about 2 months.

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日本胸部外科学会，日本心臓血管外科学会，日本人工臓器学会の3学会合同報告書の基準を満たしている陰圧吸引脱血法(VAVR)の安全性，有用性について僧帽弁置換術 82例(メイズ同時手術 46例，再手術症例 20例を含むminimally invasive cardiac surgery[MICS]の対象となる)で検討した．VAVR使用群と非使用群の間で術中因子，術後因子には差がなく，体表面積が1.5m²を越える男性にVAVR使用が多かった．

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