臨床婦人科産科71巻2号

2017年03月発行

今月の臨床 産科麻酔パーフェクトガイド

胎児手術における麻酔

著者： 大橋夕樹¹

所属機関： ¹埼玉医科大学総合医療センター産科麻酔科

ページ範囲：P.253 - P.258

●胎児手術を受ける胎児は痛みを感じる経路が完成しており，手術の際には無動とともに鎮痛が必要である．

●胎児手術はさまざまな侵襲度のものがあり，侵襲度に応じた胎児と母体に対する麻酔方法を概説した．

●重篤な疾患の胎児を手術することが多く，胎児蘇生薬の準備が必要となることが多い．

参考文献

1）Ferschl M, et al : Anesthesia for in utero repair of myelomeningocele. Anesthsiology 118 : 1211─1223, 2013

2）Y Ohashi, et al : Success rate and challenges of fetal anesthesia for ultrasound guided fetal intervention by maternal opioid and benzodiazepine administration. J Matern Fetal Neonatal Med 26 : 158─160, 2013

3）Van de Velde M, et al : Remifentanil for fetal immobilization and maternal sedation during fetoscopic surgery : a randomized, double-blind comparison with diazepam. Anesth Analg 101 : 251─258, 2005

4）入駒慎吾，他 : 胎盤吻合血管レーザー凝固術における胎児不動化のためのレミフェンタニルの至適M与量の検討．周産期学シンポジウム抄録集No.29. pp91─94, メジカルビュー社, 2011

5）Van de Velde M, et al : Fetal and maternal analgesia/anesthesia for fetal procedures. Fetal Diagn Ther 31 : 201─209, 2012

6）Van de Velde M, et al : Remifentanil for labor analgesia : an evidence-based narrative review. Int J Obstet Anesth 25 : 66─74, 2016

7）Ngamprasertwong P, et al : Update in fetal anesthesia for the ex utero intrapartum treatment（EXIT）procedure. Int Anesthesiol Clin 50 : 26─40, 2012

8）Gin T, et al : Decreased minimum alveolar concentration of isoflurane in pregnant humans. Anesthesiology 81 : 829─832, 1994

9）Chan MT, et al : Minimum alveolar concentration of halothane and enflurane are decreased in early pregnancy. Anesthesiology 85 : 782─786, 1996

10）Chan MT, et al : Postpartum changes in the minimum alveolar concentration of isoflurane. Anesthesiology 82 : 1360─1363, 1995

11）Thind AS, et al : In vitro effects of propofol on gravid human myometrium. Anesth Intensive Care 36 : 802─806, 2008

12）Kayacan N, et al : In vitro effects of opioids on pregnant uterine muscle. Adv Ther 24 : 368─375, 2007

13）Boat A, et al : Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery. Pediatr Anaesth 20 : 748─756, 2010

14）Fink RJ, et al : Remifentanil for fetal immobilization and analgesia during the ex utero intrapartum treatment procedure under combined spinal-epidural anaesthesia. Br J Anaesth 106 : 851─855, 2011

15）Ioscovich A, et al : Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment（EXIT）procedure. J Clin Anesth 23 : 142─144, 2011