口腔外科手術に応用したモルヒネ麻酔

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Morphine anesthesia is often applied for the cardiovascular surgery and to patients complicated with cardiovascular disease because it has a property of hemodynamic stability due to the block from nociceptive stimulation and pain. However, there are no reports to apply the morphine anesthesia for oral surgery cases in Japan. We tried to apply morphine anesthesia to a 73-year-old male patient scheduled for left radical neck dissection and tumorectomy under diagnosis of left maxillary carcinoma. As premedication, 0.5mg atropin sulfate and 5mg midazolam were administreted intramusclely 40 minutes before anesthesia was started. Anesthesia induction was performed by intravenous 1mg of flunitrazepam, 50mg of morphine hydrocloride, and 4mg of pancronium bromide, followed by naso-tracheal intubation. Anesthesia was maintained with only 61/min oxygen and continuous cervical epidural anesthesia for first 3hours after anesthesia induction. Thereafter, 21/min oxygen, 41/min nitrousoxide, and low dose of isoflurane were administered properly. The duration of the anesthesia and the operation were 6 hr 50 minutes and 5 hr 13 minutes respectively. As a result, sufficient hemodynamic stability was obtained during the operation, and there was no complaint of postoperative pain. Remarkable respiratory inhibition as morphine side effect during operation was observed for about 3 hours after morphine administration. However, we had no trouble since we applied control ventilation, and there was no sustained respiratory inhibition after finishing the operation. Morphine anesthesia might be good indication for long oral surgery of old patients or patients with cardiovascular disease.
奥羽大学の論文
2004-12-30

口腔外科手術に応用したモルヒネ麻酔

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