一般的な使用法：デスフルランによる麻酔導入と維持 （1）急速導入と維持，緩徐導入と維持，導入中と維持中の注意点
デスフルランは高濃度投与で気道刺激症状の頻度が増加するため緩徐導入は推奨しない．急速導入での使用は他の吸入麻酔薬と同様だが，十分な意識消失までは高濃度使用を避ける．術中維持は呼気終末麻酔ガス濃度0.7MAC以上を目安とする．クリアランスが早いため手術終了前の漸減は不要である．血管拡張作用，誘発電位抑制作用，悪性高熱発症の可能性など多くの特徴は他の吸入麻酔薬に類似する．気管支拡張作用はあるが，咳反射による気道抵抗上昇に注意する．高濃度投与で交感神経刺激作用があり心拍数の上昇を見ることがある．二酸化炭素吸収剤と反応し一酸化炭素を生成するため強アルカリを軽減した吸着剤の使用が推奨される．...
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| Published in | 日本臨床麻酔学会誌 Vol. 36; no. 3; pp. 368 - 374 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床麻酔学会
2016
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-4945 1349-9149 |
| DOI | 10.2199/jjsca.36.368 |
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| Abstract | デスフルランは高濃度投与で気道刺激症状の頻度が増加するため緩徐導入は推奨しない．急速導入での使用は他の吸入麻酔薬と同様だが，十分な意識消失までは高濃度使用を避ける．術中維持は呼気終末麻酔ガス濃度0.7MAC以上を目安とする．クリアランスが早いため手術終了前の漸減は不要である．血管拡張作用，誘発電位抑制作用，悪性高熱発症の可能性など多くの特徴は他の吸入麻酔薬に類似する．気管支拡張作用はあるが，咳反射による気道抵抗上昇に注意する．高濃度投与で交感神経刺激作用があり心拍数の上昇を見ることがある．二酸化炭素吸収剤と反応し一酸化炭素を生成するため強アルカリを軽減した吸着剤の使用が推奨される． |
|---|---|
| AbstractList | デスフルランは高濃度投与で気道刺激症状の頻度が増加するため緩徐導入は推奨しない．急速導入での使用は他の吸入麻酔薬と同様だが，十分な意識消失までは高濃度使用を避ける．術中維持は呼気終末麻酔ガス濃度0.7MAC以上を目安とする．クリアランスが早いため手術終了前の漸減は不要である．血管拡張作用，誘発電位抑制作用，悪性高熱発症の可能性など多くの特徴は他の吸入麻酔薬に類似する．気管支拡張作用はあるが，咳反射による気道抵抗上昇に注意する．高濃度投与で交感神経刺激作用があり心拍数の上昇を見ることがある．二酸化炭素吸収剤と反応し一酸化炭素を生成するため強アルカリを軽減した吸着剤の使用が推奨される． |
| Author | 佐藤, 暢一 |
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| Copyright | 2016 日本臨床麻酔学会 |
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| References | 14) Goff MJ, Arain SR, Ficke DJ, et al. : Absence of bronchodilation during desflurane anesthesia : a comparison to sevoflurane and thiopental. Anesthesiology 93 : 404-408, 2000 19) Young WL : Effects of desflurane on the central nervous system. Anesth Analg 75 (Suppl) : S32-S37, 1992 9) Avidan MS, Mashour GA : Prevention of intraoperative awareness with explicit recall : making sense of the evidence. Anesthesiology 118 : 449-456, 2013 21) Ornstein E, Young WL, Fleischer LH, et al. : Desflurane and isoflurane have similar effects on cerebral blood flow in patients with intracranial mass lesions. Anesthesiology 79 : 498-502, 1993 5) Avidan MS, Jacobsohn E, Glick D, et al. ; BAG-RECALL Research Group : Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med 365 : 591-600, 2011 15) Satoh JI, Yamakage M, Kobayashi T, et al. : Desflurane but not sevoflurane can increase lung resistance via tachykinin pathways. Br J Anaesth 102 : 704-713, 2009 11) Wiklund CU, Lim S, Lindsten U, et al. : Relaxation by sevoflurane, desflurane and halothane in the isolated guinea-pig trachea via inhibition of cholinergic neurotransmission. Br J Anaesth 83 : 422-429, 1999 13) Dikmen Y, Eminoglu E, Salihoglu Z, et al. : Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 58 : 745-748, 2003 24) Rampil IJ, Lockhart SH, Eger EI 2nd, et al. : The electroencephalographic effects of desflurane in humans. Anesthesiology 74 : 434-439, 1991 32) Wedel DJ, Gammel SA, Milde JH, et al. : Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine. Anesthesiology 78 : 1138-1144, 1993 2) TerRiet MF, DeSouza GJ, Jacobs JS, et al. : Which is most pungent : isoflurane, sevoflurane or desflurane? Br J Anaesth 85 : 305-307, 2000 25) Purdon PL, Sampson A, Pavone KJ, et al. : Clinical Electroencephalography for Anesthesiologists : Part I : Background and Basic Signatures. Anesthesiology 123 : 937-960, 2015 27) Chong CT, Manninen P, Sivanaser V, et al. : Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring. J Neurosurg Anesthesiol 26 : 306-312, 2014 12) Park KW, Dai HB, Lowenstein E, et al. : Epithelial dependence of the bronchodilatory effect of sevoflurane and desflurane in rat distal bronchi. Anesth Analg 86 : 646-651, 1998 10) Mazzeo AJ, Cheng EY, Bosnjak ZJ, et al. : Differential effects of desflurane and halothane on peripheral airway smooth muscle. Br J Anaesth 76 : 841-846, 1996 23) Kaye A, Kucera IJ, Heavner J, et al. : The comparative effects of desflurane and isoflurane on lumbar cerebrospinal fluid pressure in patients undergoing craniotomy for supratentorial tumors. Anesth Analg 98 : 1127-1132, 2004 29) Kodama M, Satoh Y, Otsubo Y, et al. : Neonatal desflurane exposure induces more robust neuroapoptosis than do isoflurane and sevoflurane and impairs working memory. Anesthesiology 115 : 979-991, 2011 8) Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A : Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev (4) : CD003843, 2007 22) Fraga M, Rama-Maceiras P, Rodiño S, et al. : The effects of isoflurane and desflurane on intracranial pressure, cerebral perfusion pressure, and cerebral arteriovenous oxygen content difference in normocapnic patients with supratentorial brain tumors. Anesthesiology 98 : 1085-1090, 2003 4) Avidan MS, Zhang L, Burnside BA, et al. : Anesthesia awareness and the bispectral index. N Engl J Med 358 : 1097-1108, 2008 33) Visoiu M, Young MC, Wieland K, et al. : Anesthetic drugs and onset of malignant hyperthermia. Anesth Analg 118 : 388-396, 2014 3) Myles PS, Leslie K, McNeil J, et al. : Bispectral index monitoring to prevent awareness during anaesthesia : the B-Aware randomised controlled trial. Lancet 363 : 1757-1763, 2004 26) Malcharek MJ, Loeffler S, Schiefer D, et al. : Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial. Clin Neurophysiol 126 : 1825-1832, 2015 31) Istaphanous GK, Howard J, Nan X, et al. : Comparison of the neuroapoptotic properties of equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in neonatal mice. Anesthesiology 114 : 578-587, 2011 28) Kim JK, Kim DK, Lee MJ : Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia. J Int Med Res 42 : 130-137, 2014 17) Weiskopf RB, Eger EI 2nd, Noorani M, et al. : Fentanyl, esmolol, and clonidine blunt the transient cardiovascular stimulation induced by desflurane in humans. Anesthesiology 81 : 1350-1355, 1994 16) Ebert TJ, Muzi M : Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology 79 : 444-453, 1993 20) Muzzi DA, Losasso TJ, Dietz NM, et al. : The effect of desflurane and isoflurane on cerebrospinal fluid pressure in humans with supratentorial mass lesions. Anesthesiology 76 : 720-724, 1992 7) Fritz BA, Rao P, Mashour GA, et al. : Postoperative recovery with bispectral index versus anesthetic concentration-guided protocols. Anesthesiology 118 : 1113-1122, 2013 1) Arain SR, Shankar H, Ebert TJ : Desflurane enhances reactivity during the use of the laryngeal mask airway. Anesthesiology 103 : 495-499, 2005 30) Shen X, Dong Y, Xu Z, et al. : Selective anesthesia-induced neuroinflammation in developing mouse brain and cognitive impairment. Anesthesiology 118 : 502-515, 2013 6) Mashour GA, Shanks A, Tremper KK, et al. : Prevention of intraoperative awareness with explicit recall in an unselected surgical population : a randomized comparative effectiveness trial. Anesthesiology 117 : 717-725, 2012 18) Royse CF, Liew DF, Wright CE, et al. : Persistent depression of contractility and vasodilation with propofol but not with sevoflurane or desflurane in rabbits. Anesthesiology 108 : 87-93, 2008 |
| References_xml | – reference: 8) Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A : Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev (4) : CD003843, 2007 – reference: 23) Kaye A, Kucera IJ, Heavner J, et al. : The comparative effects of desflurane and isoflurane on lumbar cerebrospinal fluid pressure in patients undergoing craniotomy for supratentorial tumors. Anesth Analg 98 : 1127-1132, 2004 – reference: 19) Young WL : Effects of desflurane on the central nervous system. Anesth Analg 75 (Suppl) : S32-S37, 1992 – reference: 14) Goff MJ, Arain SR, Ficke DJ, et al. : Absence of bronchodilation during desflurane anesthesia : a comparison to sevoflurane and thiopental. Anesthesiology 93 : 404-408, 2000 – reference: 31) Istaphanous GK, Howard J, Nan X, et al. : Comparison of the neuroapoptotic properties of equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in neonatal mice. Anesthesiology 114 : 578-587, 2011 – reference: 26) Malcharek MJ, Loeffler S, Schiefer D, et al. : Transcranial motor evoked potentials during anesthesia with desflurane versus propofol--A prospective randomized trial. Clin Neurophysiol 126 : 1825-1832, 2015 – reference: 7) Fritz BA, Rao P, Mashour GA, et al. : Postoperative recovery with bispectral index versus anesthetic concentration-guided protocols. Anesthesiology 118 : 1113-1122, 2013 – reference: 1) Arain SR, Shankar H, Ebert TJ : Desflurane enhances reactivity during the use of the laryngeal mask airway. Anesthesiology 103 : 495-499, 2005 – reference: 3) Myles PS, Leslie K, McNeil J, et al. : Bispectral index monitoring to prevent awareness during anaesthesia : the B-Aware randomised controlled trial. Lancet 363 : 1757-1763, 2004 – reference: 11) Wiklund CU, Lim S, Lindsten U, et al. : Relaxation by sevoflurane, desflurane and halothane in the isolated guinea-pig trachea via inhibition of cholinergic neurotransmission. Br J Anaesth 83 : 422-429, 1999 – reference: 21) Ornstein E, Young WL, Fleischer LH, et al. : Desflurane and isoflurane have similar effects on cerebral blood flow in patients with intracranial mass lesions. Anesthesiology 79 : 498-502, 1993 – reference: 25) Purdon PL, Sampson A, Pavone KJ, et al. : Clinical Electroencephalography for Anesthesiologists : Part I : Background and Basic Signatures. Anesthesiology 123 : 937-960, 2015 – reference: 20) Muzzi DA, Losasso TJ, Dietz NM, et al. : The effect of desflurane and isoflurane on cerebrospinal fluid pressure in humans with supratentorial mass lesions. Anesthesiology 76 : 720-724, 1992 – reference: 17) Weiskopf RB, Eger EI 2nd, Noorani M, et al. : Fentanyl, esmolol, and clonidine blunt the transient cardiovascular stimulation induced by desflurane in humans. Anesthesiology 81 : 1350-1355, 1994 – reference: 12) Park KW, Dai HB, Lowenstein E, et al. : Epithelial dependence of the bronchodilatory effect of sevoflurane and desflurane in rat distal bronchi. Anesth Analg 86 : 646-651, 1998 – reference: 18) Royse CF, Liew DF, Wright CE, et al. : Persistent depression of contractility and vasodilation with propofol but not with sevoflurane or desflurane in rabbits. Anesthesiology 108 : 87-93, 2008 – reference: 24) Rampil IJ, Lockhart SH, Eger EI 2nd, et al. : The electroencephalographic effects of desflurane in humans. Anesthesiology 74 : 434-439, 1991 – reference: 4) Avidan MS, Zhang L, Burnside BA, et al. : Anesthesia awareness and the bispectral index. N Engl J Med 358 : 1097-1108, 2008 – reference: 6) Mashour GA, Shanks A, Tremper KK, et al. : Prevention of intraoperative awareness with explicit recall in an unselected surgical population : a randomized comparative effectiveness trial. Anesthesiology 117 : 717-725, 2012 – reference: 2) TerRiet MF, DeSouza GJ, Jacobs JS, et al. : Which is most pungent : isoflurane, sevoflurane or desflurane? Br J Anaesth 85 : 305-307, 2000 – reference: 33) Visoiu M, Young MC, Wieland K, et al. : Anesthetic drugs and onset of malignant hyperthermia. Anesth Analg 118 : 388-396, 2014 – reference: 5) Avidan MS, Jacobsohn E, Glick D, et al. ; BAG-RECALL Research Group : Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med 365 : 591-600, 2011 – reference: 32) Wedel DJ, Gammel SA, Milde JH, et al. : Delayed onset of malignant hyperthermia induced by isoflurane and desflurane compared with halothane in susceptible swine. Anesthesiology 78 : 1138-1144, 1993 – reference: 16) Ebert TJ, Muzi M : Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology 79 : 444-453, 1993 – reference: 10) Mazzeo AJ, Cheng EY, Bosnjak ZJ, et al. : Differential effects of desflurane and halothane on peripheral airway smooth muscle. Br J Anaesth 76 : 841-846, 1996 – reference: 30) Shen X, Dong Y, Xu Z, et al. : Selective anesthesia-induced neuroinflammation in developing mouse brain and cognitive impairment. Anesthesiology 118 : 502-515, 2013 – reference: 29) Kodama M, Satoh Y, Otsubo Y, et al. : Neonatal desflurane exposure induces more robust neuroapoptosis than do isoflurane and sevoflurane and impairs working memory. Anesthesiology 115 : 979-991, 2011 – reference: 9) Avidan MS, Mashour GA : Prevention of intraoperative awareness with explicit recall : making sense of the evidence. Anesthesiology 118 : 449-456, 2013 – reference: 15) Satoh JI, Yamakage M, Kobayashi T, et al. : Desflurane but not sevoflurane can increase lung resistance via tachykinin pathways. Br J Anaesth 102 : 704-713, 2009 – reference: 22) Fraga M, Rama-Maceiras P, Rodiño S, et al. : The effects of isoflurane and desflurane on intracranial pressure, cerebral perfusion pressure, and cerebral arteriovenous oxygen content difference in normocapnic patients with supratentorial brain tumors. Anesthesiology 98 : 1085-1090, 2003 – reference: 27) Chong CT, Manninen P, Sivanaser V, et al. : Direct comparison of the effect of desflurane and sevoflurane on intraoperative motor-evoked potentials monitoring. J Neurosurg Anesthesiol 26 : 306-312, 2014 – reference: 28) Kim JK, Kim DK, Lee MJ : Relationship of bispectral index to minimum alveolar concentration during isoflurane, sevoflurane or desflurane anaesthesia. J Int Med Res 42 : 130-137, 2014 – reference: 13) Dikmen Y, Eminoglu E, Salihoglu Z, et al. : Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia 58 : 745-748, 2003 |
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| SubjectTerms | デスフルラン 合併症 麻酔導入 麻酔維持 |
| Title | 一般的な使用法：デスフルランによる麻酔導入と維持 （1）急速導入と維持，緩徐導入と維持，導入中と維持中の注意点 |
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