未透析慢性腎不全患者の全身麻酔経験

概要

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A 36-year-old woman with non-hemodialysis chronic renal failure (NHCRF) was scheduled for cyctectomy and tooth extraction under general anesthesia. Midazolam 3mg was given intravenously as a pre-medication. Anesthesia was induced with midazolam 3mg and pentazocine 7.5mg, then was started with 2L/min oxygen, 4L/min nitrous oxide and 1.5〜3% sevoflurane. Nasotracheal intubation was performed without muscle relaxants to avoid sustained effect of muscle relaxants. After local anesthesia (2% lidocaine with 1:80,000 epinephrine), anesthesia was maintained with 2L/min oxygen, 4L/min nitrous oxide and 0.3〜1.0% isoflurane. During and after operation, her systolic blood pressure could be kept up to 100mmHg with 7.5mg pentazocine in the inductuion and continuous infusion of 3μg/kg/min dopamine. As a result, no complications were observed, and plasma creatinine concentration, had a tendency to decrease. The patient was discharged from the hospital without renal dysfunction on the third postoperative day. This case suggests that we should be aware to keep renal blood flow and avoid unnecessary drugs in anesthetic management for NHCRF.
奥羽大学の論文
2005-12-30