老人麻酔の臨床的検討
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概要
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Clinical data of 288 elderly patients who received general, spinal or epidural anesthesia from June 1976 through September 1977 were studied, as compared to 43 patients from 40 to 55 years of age (A group) . The elderly patients included 213 patients from 65 to 74 years of age (B group) and 75 patients above 75 years of age (C group) .<BR>Results are as follows :<BR>1. Induction dose of thiamylal and maintenance concentration of halothane were distributed more frequently to lowest range in C group, to middle range in B group, and to highest range in A group, respectively. However, dose or concentration required in a few elderly patients were as large as in A group, suggesting disparity between chronological and biological age.<BR>2. Dose (mg/kg/hour) of pancuronium necessary for abdominal muscle relaxation was larger in B group than in A group, being largest in C group. The elderly patients anesthetized with neuroleptanesthesia required more pancuronium than the patients under nitrous oxide-oxygen-halothane anesthesia.<BR>3. The intraoperative fluid requirements, usually about 8-9 ml/kg/hour, were increased in the patients undergoing prostatectomy or anesthetized with neuroleptanesthesia, as compared with other cases.<BR>4. Results failed to show a significant correlation between urinary output and the volume of the intraoperative fluids.<BR>5. Hypotension following induction and endotracheal intubation was observed in about one-third of the cases anesthetized with thiamylal, and in more than half of the cases anesthetized with neuroleptanesthesia or ketamine, which was used for the patients with bronchial asthma or bleeding.<BR>6. During gastrectomy under nitrous oxide-oxygen-halothane anesthesia, blood pressures were higher in C group than in B group. The elderly patients undergoing gastrectomy under neuroleptanesthesia showed higher blood pressure than the patients under nitrous oxide-oxygen-halothane anesthesia, during earlier period of surgical procedure. However, this relationship was reversed during later period of surgical procedure.<BR>7. During prostatectomy, blood pressures were lower in B group under epidural anesthesia than in the elderly patients under nitrous oxide-oxygen-halothane anesthesia, being lowest in C group under epidural anesthesia.<BR>8. The incidence of hypotension to be treated with vasopressor was higher in neuro-leptanesthesia than in spinal anesthesia, being highest in epidural anesthesia.<BR>9. The incidence of hypertension above 160 mmHg was higher in the patients with hypertension or anesthetized with neuroleptanestheisa, as compared to other cases.<BR>10. The need for blood transfusion was determined by preoperative hematocrit, blood loss, and the age of the patient.
- 学校法人 昭和大学・昭和医学会の論文