479 デスフルランの上手な使い方日臨麻会誌 Vol.36 No.4, 479 483, 2016 各科手術での使用 : 高齢者手術 高齢者への応用の長所 短所 * 矢野武志 * 恒吉勇男 [ 要旨 ] 本稿では, 高齢者に対するデスフルランの長所と短所に着目し, 効果的な使用方法を検討した. 高齢者を対象とした多くの研究結果から, デスフルランの最大の長所は覚醒が早いことであり, 覚醒遅延が危惧される高齢者手術において, 有用であると考えられた. また, 認知症に対する影響が軽微である可能性や気道反射回復による誤嚥回避の可能性も長所として示唆された. 一方, 早期覚醒によって出現する心血管反応や術後疼痛が高まる点に関しては短所であると考えられた. 高齢者においては, これらの長所と短所は諸刃の剣となり, 重篤な状態に陥る可能性もあることから, 確実な術後鎮痛を計画するなど, デスフルランの特徴を十分に理解した対応が必要である. キーワード :デスフルラン, 高齢者手術, 認知機能, 認知症, アミロイドβ はじめに 2015 65 26 1 2014 65 55 75 30 2 図 1 75 2002 2014 7 15 2 2 3 1992 Ⅰ 長 1. 高齢者でも覚醒が早い 2000 4 7 8 8 3 表 1 9 所 889-1692 5200
480 Vol.36 No.4/Jul. 2016 図 1 調査期間中に手術を受けた年齢別患者数の年次推移 10 11 4, 5, 12, 13 14 2. 認知症への影響が軽微? 2012 462 65 15 15 16 17 18 19 16, 20 21 3. 気道反射の回復が早い 22 23
481 表 1 高齢者においてデスフルランの方が覚醒が早かった代表的なランダム比較対象研究 ( 発行年順 ) 3 4 24 Ⅱ 短所 1. 覚醒後の循環動態不安定 25 27 28 29 2. 術後鎮痛に要注意 6 30 まとめ 31 参考文献 1) 内閣府 : 高齢社会白書 ( 平成 25 年版 ).2013 2) 厚生労働省 : 推計退院患者数, 手術の有無 手術名 性 年齢階級 病院 一般診療所別, 平成 26 年患者調査.2014 3) Kruijt Spanjer MR, Bakker NA, Absalom AR:Pharmacology in the elderly and newer anaesthesia drugs. Best Pract Res Clin Anaesthesiol 25:355-365, 2011 4) Chen X, Zhao M, White PF, et al.:the recovery of cognitive function after general anesthesia in elderly patients:a comparison of desflurane and sevoflurane.
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