小児“もやもや”病の麻酔

概要

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To evaluate causes of anesthesia induced acute neurological symptoms in children with “Moyamoya” disease, we studied the relationships between internal jugular oxygen tension (PjO2) and arterial carbon dioxide tension (PaCO2), and PjO2 and mean arterial blood pressure (MAP) during diazepam-fentanyl (mNLA) or halothane anesthesia (GOF) for ST-MC anastomosis, EMS or CAG. The linear regression equation, PjO2=0.971×PaCO2-0.703 (r=0.789, p<0.01), was obtained for PjO2and PaCO2during mNLA. However no significant relationship between PjO2and MAP was recognized during mNLA. The equation, PjO2=0.949×PaCO2-0.022 MAP+2.682 (R=0.572, p<0.01), was obtained by multiple regression analysis for mNLA. During GOF the equation, PjO2=1.064×PaCO2+2.603 (r=0.803, p<0.01) and PjO2=0.308×MAP+16.631 (r =0.861, p<0.01) were obtained respectively. Multiple regression analysis revealed the equation, PjO2=1.103×PaCO2+0.111×MAP-9.618 (P=0.741, p<0.01), during GOF. These findings suggest that hypocarbia is one of the important factors which deteriorate neurological symptoms during anesthesia in “Moyamoya” disease and moderate hypercarbia should be maintained during anesthesia, especially in mNLA. During GOF hypotension, as well as hypocarbia, is a deteriorating factor.