Transcription of －安全な麻酔管理のために－ - anesth.or.jp
1 1 2016 2016 8 WG 2 .. * Q&A . 10 MH 13 . 15 16 : MH 17 : MH 18 PMH 19 3 Malignant hyperthermia.
2 MH MH MH MH COI MH MH MH MH MH PMH 10 1 2 1960 400 3 1 1960 70-80 2000 15 10 4 MH Ca Ca MH 55 mmHg ETCO2 15 C 40 C
3 T disseminated intravascular coagulation: DIC MH Ca Ca Ca Ca MH Ca ATP Ca ATP ATP Ca A2 PLA2 MH
4 CK 5 MH Ca 1 :RYR1 Ca MH 1) 2) 3) Clinical Grading Scale 4) 3) 1. Harrison GG: Control of the malignant hyperpyrexia syndrome in MHS swine by dantrolene sodium. Br J Anaesth 1975; 47: 62-5 2. Kolb ME, Horne ML, Martz R: Dantrolene in human malignant hyperthermia. A multicenter study. Anesthesiology 1982; 56: 254-262 3. , , 1988; 80: 771-9 4. Larach MG, Localio AR, Allen GC, et al.
5 : A clinical grading scale to predict malignant hyperthermia susceptibility. Anesthesiology 1994; 80: 771-9 6 MH MH 2 MH MH ETCO2 15 C C BE PaCO2 < ETCO2 ETCO2 ( 2) MH PMH 30 PMH MH MH MH 30 2 70 24 90 30 2 MH ( 3)
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7 000 mg 14 CK DIC 30 4 12 24 48 15 ETCO2 MH PMH ** Q&A ** a) Q A ETCO2 MH b) Q 8 A MH MH 40 C 37 C ETCO2 MH c) Q A MH d)
8 Q MH A MH MH 48 e) Q A MH ** 9 1) MH (1) ETCO2, PaCO2 ( ), ( ), ( 2 1 . 1%) Riazi S, et al: Anesth Analg 2014; 118: 381-7 (2) ( ), ( ), ETCO2, PaCO2 ( ) Visoiu M, et al: Anesth Analg 2014; 118: 388-96 2) ( ) Glahn KP, et al: Br J Anaesth 2010; 105: 417-20 3) PaCO2>60mmHg pH< BE< Clinical Grading Scale Larach MG, et al: Anesthesiology 1994; 80: 771-9 4) PaCO2 < ETCO2 (1) Lin HT, et al: J Chin Med Assoc 2014; 77: 209-12, (2) Kwetny I, et al: Anesth Analg 2006; 102: 815 7 5) Kwetny I, et al: Anesth Analg 2006.
9 102: 815 7 6) MH CO2 Jones C, et al: Anaesth Intensive Care 2012; 40: 490-7 7) MH (1) Nelson P, et al: Anesth Analg 2014; 118: 369 74 (2) Burkman JM, et al: Anesthesiology 2007; 106: 901-6 8) MH 9) MH Bandschapp O, et al: Swiss Med Wkly 2012; 142: w13652 10) PMH : 2013; 49: 7-11 10 . MH a) MH MH MH MH MH 1 b) MH RYR1 2 3 MH RYR1 3 4 MH 5 c) CK CK MH 1 CK IVCT (in-vitro contracture test) 49 6) 37 2 7) CICR(Ca-induced Ca release) 8) CK RYR1 9) 10)
10 D) MH 1) 11) 12) MH RYR1 MH Central Core Disease Multi-minicore Disease King Denborough Congenital fiber type disportion (CFTD) e) MH f) 13) 14) 1) g) 1)15) h) mg/kg 1 20 mg 60 ml i)
