心移植後の子宮体癌手術に対する麻酔経験

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We describe our experience with a 53-year-old woman who underwent anesthesia after cardiac transplantation. In 2004, the patient underwent cardiac transplantation in the United States because of refractory heart failure due to dilated cardiomyopathy. After returning to Japan, she received post-transplant therapy and care at the department of internal medicine and recovered uneventfully. Radical surgery for endometrial cancer was performed. The following anesthetics were used: intramuscular atropine and midazolam premedication; thiopental and vecuronium for the induction of anesthesia; and sevoflurane, nitrous oxide, and fentanyl for the maintenance of anesthesia. Hemodynamic variables were monitored continuously: blood pressure was measured nonin-vasively, and central venous pressure, the electrocardiogram, and heart rate were continuously recorded. As an index of heart-rate variability, R-R intervals were measured. The root-mean-square of the difference of the R-R interval from the next value was calculated, which is considered approximately equivalent to the standard deviation of the R-R interval (SDNN). The heart rate ranged from 60 to 80 beats per minute. On continuous cardiac monitoring, the SDNN of the R-R interval was 8.11 ms before surgery, 8.16 ms during surgery, and 8.27 ms after surgery. Recovery of innervation of the transplanted heart has been reported to vary depending on the patient. SDNN did not significantly change in our patient, despite the fluctuations in heart rate before, during, and after surgery. Heart-rate variability apparently originated from the sinus node; the role of vagal innervation was minimal. In the transplanted heart, cardiac output depends on preload. Hemodynamics were stably managed by controlling the water balance, using central venous pressure as an index.
東京女子医科大学の論文

心移植後の子宮体癌手術に対する麻酔経験

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