秋田大学麻酔科研修マニュアル - med.akita-u.ac.jp

1 2 2009 1. 2. 6 3. 15 4. 29 5. 36 6. 38 7. 39 8. 42 9. 44 10. 47 11. ( ) 51 12. 53 13. 55 14. TUR 56 15. 57 16. 58 17. CPR ( ) 59 18. 60 19. 61 2 2/62. 1.. mg . ml .. 2 3/62.. (1) . (2) (1) . (2) (3) (4) 1 2 4/62. (1) (Peripheral Intravenous Catheter) (2) ( racheal Intubation) (3) ( ) (4) (Arterial Line) (5) (Central Venous Catheter) (6) (Swan-Ganz Catheter) (1) 8 00 7 45 8 45 2 5/62.. (2) .. IN .. 5:15.. (1) 2 6/62.. (2) 21 Full Stomach (3) 2 7/62. 90 : : 2 5 mg H2 : 150 mg 10 mg . : 65 . ORSYS .. 5 15 . 6404 Withdrawal Rebound ACE- . (4) Presentation . 2 8/62.. 250 mg 100 g 50mg 8 mm . A-line 1 ( ) 1.. 1 ME . 1000 kPa . 5 L/min .. 400 kPa 370 kPa . 5 L/min .. 2 9/62.. 5-10 L/min 10 . 30 cmH2O.

2 APL .. 4% 2 10/62. 1 3 500ml 1000 300 mmHg 40 kPa 100 150 mmHg 15 20 kPa . thiopental 300 mg 12 ml propofol vecuronium 10 mg 10 ml rocuronium ephedrine 40 mg 8 ml atropine fentanyl remifentanil 1 V(20 mg)/20 ml 2 11/62. ( ) .. 1 .. ml 1 . (X-1) . (1) . 2 12/62.. (2) ( . ) . ( ) 20 G .. % .. 2 13/62.. EtCO2 (5) (6) .. (7) . 2 14/62.. ORSYS .. * ASA Physical Status Class 1. A normal, healthy person. 2 15/62. Class 2. A patient with a mild systemic disease. Class 3. A patient with a severe systemic disease that limits activity but is not incapacitating. Class 4. A patient with an incapacitating systemic disease that is a constant threat to life. Class 5. A moribund patient who is not expected to survive 24 hr with or without surgery.

3 Class 6. Brain died patient. Emergency (E) A patient in one of the preceding classes who is undergoing surgery as an emergency. The letter E is written next to the numerical classification. 2E E (1) 1) wheezing 2 16/62. 2) 1 Wheezing 3) 5 mg/kg/30 min mg/kg/hr 100-250 mg 8 ml * : : 1) Hugh-Johnes : 6 2 17/62. X 2) * : 1 * : 1 SpO2 ETCO2 (2) 1) ASA 3 2 2) 2 18/62. ACE . 3) . 4) ! ! 2 19/62. @sysdate@systime . : . @username @usersection . ID: @patientid . @patientname @patientagey ear . @patientsexn .. 3) .. ). Q .. ST-T .. 2 2-1 .. 2 20/62.. PCI .. DES) . TIA .. 2 . @sysdate@systime . ID: @patientid @patientname @patientageyear @patientsexn Mets) .. Mets .. Mets . Mets . BP HR.. Mets . 7 Mets.

4 Mets . 5 Mets). Mets . Mets . (4km/h) .. Mets .. 3Km/h) .. Mets .. Mets . Mets .. Mets .. 2 21/62.. 2 22/62. 2 23/62. 1) ! . X Holter . 2) . 10 14 1 .. 3) (Swan-Ganz Catheter) .. 4) 2 24/62. Ca +. Mg2+ Ach .. 3 . 1) 5 / . R on T Short Run 2) Block, 1 2 Mobitz . Mobitz II . 2 25/62. 3 .. (3) 1) ? 3 1. 2 2. 3. * .. * . 2) 2 26/62. 6 2 3) 1 2 check 100 200 mg/dl 250 mg/dl 200 mg/dl NIDDM IDDM .. 50 % 10 20 ml 80 mg dl 30 250 300 mg/dl 6 300 350 mg/dl 8 350 400 mg/dl 12 400 * Class 1. Class 2. Class 3. 2 27/62. Class 4. (Goldman) 1. : 1) 70 2) 6 2. : 1) 2) 3. : 1) PAC 2) 1 5 PVC 4. : 1) PO2 60 mmHg or PCO2 50 mmHg 2) K+ mmHg or HCO3+ 20 mEq/L 3) BUN 50 mg/dl or Cr mg/dl 4) Abnormal SGOT, 5. : 1) 2) DNA PCR 2 28/62.

5 6 L/min . FRC . (Rapid Induction) 4 6 mg/kg .. mg/kg .. 4 % . 2 3 cm .. 2 29/62. 20 cmH2O . Wheezing . * . * 1) 2) 3) ( Pierre-Robin syndrome) 4) 5) ( ) 6) (2) (Rapid Sequence Induction Crash Induction) : Full Stomach : 2 30/62. Precuralization : mg/kg 100 % 7 4 7 mg/kg . 2 3 mg/kg .. (3) (Awake Tracheal Intubation) : Full Stomach : . 4 % 23 G 4 . 2 ml .. * : (4) (Slow Induction) 2 31/62. : : 2 L/min 4 L/min 2 3 % (5) : .. (1) . TOF 1/4 2 32/62.. (2) PAR Score 5 TOF; 70 % 50 Hz 5 PaCO2 50 mmHg (3) ( ) 20 cmH2O .. * Th4.. (Postanesthetic Recovery Score; PAR Score) 2 33/62. (15 ) 2 1 0 2 1 0 20 mmHg 2 20 50 mmHg 1 50 mmHg 0 2 1 0 2 1 0 10 * 8 .. N95 .. ICU .. 1) (ECG) 2 34/62. 2) ( ) (BP) 3) (HR) (PR) 4) (SpO2) 5) (EtCO2) 6) 7) (FiO2) 8) (Air Way Pressure) 9) (In-Out) (1) +V5 (2).

6 : : : 22 24 G 22 G : 3 ml (3) : . : ( ) * : 2 35/62. (4) ( - ) : .. V/F . * : * : + 2 3 ml/kg/h * 6 8 ml/kg/hr * : 10 ml/kg/hr * : 3 6 ml/kg/h 3 . 1 ml/kg/h . 2 36/62. FFP PPF Ht 30 % . 20 % FFP DIC 50 % 15 20 % 2 3 20 50 % 50 100 % 24 100 % 2 37/62. * 90 mmHg 60 70 mmHg 1 ml/kg/h . (1) : : . : (2) . mg/kg mg/kg 0,1 mg/kg 1 mg/kg . Phase Block .. 2 38/62.. (3) mg/kg + mg/kg TOF 1/4 . * . PaCO2 50 mmHg . Ca2+blocker . (1) ( ) (2) 2 39/62. * (3) (4) L3/4 168 cm T10 . 10 mg .. (5) ( ) . : 5 ml . % 23 G 2 40/62. 2 3 . 23 G 27 GQuincke .. 3 cm . 1 mm/ . ml/sec .. 10 15 (1 ) . 5 ! CSEA (6) 5 10 mg 50 100 g . (7) 1 mg 1 A. 2 41/62. 5 mg (8) T4-5 T4 . (1) (2) (3) % E 1 % E 10 ml + 2 % 10 ml 2 % E (4) % (Tuohy ) 3 ml.

7 3 1 2 mm 2 42/62.. 3 4 cm 10 cm .. 15 cm .. 3 . % E 3 ml . 3 20 bpm .. (5) 2 43/62. 30 90 (6) 2 mg 5 10 ml 2 6 50 100 g 5 10 ml (7) : : 4ml/h . 2ml .. 38 BCG 1 .. 2 * . 2 44/62.. Clear water 6 6 3 3 6 6 40 2 4 mg/kg (100 mg ) ml/kg (15 ml ) ml/kg 90 mg/kg * 2 3 Clear Water . Clear Water . 10 ml/kg (1) 10 kg Maplson's D 15 kg 2 45/62. (2) : (kg)/10 L (3) ID .. mm .. mm .. mm + (4) 2/3 (5) V/F 500 ml 50 % Glucose 20 ml 2 % D T3 T1 20 kg . x 1 . x 2 (kg) (ml/kg/ ) 2 46/62. 3 ml/kg/ 4 10 kg 4 ml/kg/ 11 20 kg 40 + 2 (V-10) ml/kg/ 21kg 60 + (V-20) ml/kg/ (V ) . : 45 mg/kg 5 10 mg 90 mg/kg 45 NYHA Class 3-4 .. 3 L/min : : : : . : 4 5 . 2 47/62. 2 % . 200 300 U/kg (DOA, ) 3 20 g/kg/min (DOB, ) 3 20 g/kg/min g/kg/min g/kg/min g/kg/min mg/kg : 10 g/kg/min V5 Swan-Ganz Catheter (CCO) INVOS ( ).

8 2 48/62. 3 5 g/kg . mg/kg Rigidity 4 % .. S G * * . 200 300 U/kg . 3 ACT 300 3 L/min ? ? ? ? ? : mg/kg/h 2 49/62.. * 35 (CVP PCWP LAP ) ACT . 30 ACT ACT .. ICU SpO2 .. 2 50/62.. ICU Swan-Ganz Catheter . 3-5 . ICU . ( ) * . * : . : . Swan-Ganz 2 51/62. F + . A ( ) .. 50 % 5 . PaO2 100 mmHg . 95 % 90 % CPAP . 2 52/62.. PaO2 350 mmHg PaCO2 40 mmHg .. Fetal Distress 1000 2000 ml . T4 . 2 53/62. L2/3 L3/4 10mg 20 .. 20 1 30 % 100 mmHg . 5 10 mg 3 4 - 5 mg/kg mg/kg . (Cricoid Pressure) Full Stomach 3 L/min + 3 L/min + ( % % ) 20 . Sleeping Baby PaCO2 20 mmHg .. 2 54/62. CT : : 4 6 mg/kg (PaCO2 =30 35 mmHg) 1-2 2 % 2 mg/kg MEP . MEP . TCI .. 2 55/62. Cushing . (V-P ) ..TUR * ( ) . TUR-P . Na TUR-P ( T10 ) : 2 56/62.

9 Wheezing Hypoxia Hyponatremi : * * 3 % 10 20 mg .. 1 % .. * Donor . 1000 mg + 100 ml 1000 ml 10 % 500 ml+ 500 ml+20 % . 60 ml 300 ml 2 57/62. Recipient . 50 ml 2 ml/h 20 mg . 100 ml 500 mg + 500 ml . 8cmH2O . 3 g/kg/min 160 mmHg F PPF FFP .. 150cm 200ml 6A 4ml/hr 200ml 6A 4ml/hr 150cm 100ml 6A ml/hr 100ml 6A 2ml/hr 150cm 200ml 6A 4ml/hr 200ml 6A 4ml/hr 150cm 100ml 6A 2ml/hr 100ml 6A 2ml/hr 2 58/62. IV-PCA . 10A 40ml 1ml 20 g/ml 2 ml/hr lockout 20 bolus 1ml 1 100 .CPR ( ) * Near Arrest . (CPR) (1) ; mg/kg ; mg/kg SCC GI 10 15 CPR ; g/kg/min 2 59/62. ; g/kg/min Ca (2) (Near Arrest ) 1) 2) 3) 4) 80-100 / 60 mmHg 5) 6) (DC) 200 J ; VF, VT 1 mg 3 . 200 300 360 J mg/kg . ( ) 2 60/62. 2 % 1/1000 1/1000 ml 15 ml 15 2 4 ml.

10 CPK . CPK . SCC EtCO2 2 61/62. 15 1 2 mg/kg * 10 mg/kg 5 2 4 mEq/kg 38 25 g 20 mg .. 2 62/62.