帝王切開術の麻酔 : 教室における帝切麻酔の統計を中心として
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In the past ten years period 1957-1966, 568 caesarean sections were performed. 336 cases among them were done under general anaesthesia, 141 spinals, 79 epidurals, and 12 locals. By Brodie' method, thiopental level in both meternal and foetal blood were quantitatively determined to analyse the placental transmission of this agent in 20 normal deliverlies. The fixation of the anaesthetic drug as the mode of action spinal anaesthesia was studied in 30 caesarean sections (elective cases). Results:- 1. Premedication with atropine must be part of any anaesthesia. There was less neonatal depression following atropine than when opiate was used. 2. Thiopental concentration in the maternal cuvital vein was rapidly decreased, which appeared within 40 seconds in the umbilical blood, while that in the umbilical artery revealed the highest concentration at 8 minutes. Apgar's score in this series showed significant correlationships with duration of anaesthesia. 3. The transmission of muscle relaxants were not any care about its clinical use in many cases. In view of anaesthetic complications, S.C.C. should be prefered to other muscle relaxants in caesarean section. 4. 0.3% Percamine hyperbaric solution was injected under a conventional spinal method to caesarean section patients. It took more than 30 minutes to show complete fixation of anaesthesia at any position of patients. The vaso-pressor should given before the start of spinal puncture for sudden falling of systolic blood pressure. 5. In neonatal depression, the difference was not statistically significant in any anaesthetic method. There was less neonatal depression following general anaesthesia in maternal haemorrhagic case than when other anaesthesia was used, in premature local anaesthesia was better than others. The results were most satisfactory and confirm, the utilization of a small induction dose of thiopental, followed by a relaxant (S.C.C.) with nitrous oxide and oxygen, caused less neonatal depression than other forms of general anaesthesia. Spinal and epidural are obviously contra-indicated under maternal haemorrhage. 6. There were two maternal deaths in this series.
- 千葉大学の論文
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