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神経線維腫症1型患者の皮弁形成術後20年目に生じた特発性皮下血腫に対して経カテーテル的出血コントロールに成功した一例
Full text link神経線維腫症1型患者（NF1）で、頸部神経鞘腫術後の皮弁移植形成術後20年目に特発性に血腫を生じ、経カテーテル的動脈塞栓術（TAE）によって出血コントロールを得られた一例を経験したので報告する。症例は60 代女性で、右後頭部腫脹のため近医を受診し、精査にて活動性出血を伴う皮下血腫と貧血、臨床的にショックバイタルが判明したため当院へ救急搬送された。転院当日に主要な出血源である右後頭動脈に対しTAE が行われた。右顔面動脈領域にも少量のextravasation が認められたが、皮弁の虚血リスクを考慮し、顔面動脈の塞栓は行わずに手技を終了した。しかし翌日に血腫増大を認めたため、右顔面動脈に対するTAEも追加で施行した。術後には皮弁の壊死を認めたが、デブリードマンを繰り返し，同部は肉芽形成が確認されるまでに改善した。NF1の出血に対しては血管脆弱性のため外科的な止血処置が困難な場合もあり，比較的低侵襲で効果的な報告が近年増加しているTAEが適応となる場合も多い。皮弁形成部分に対するTAEは塞栓範囲の決定が非常に難し
いが、本症例からは複数科と協議の上で皮弁形成部の壊死をどの程度まで許容して，出血コントロールを優先するかを決定する事も重要であると考える
The Association Between Intraoperative Objective Neuromuscular Monitoring and Rocuronium Consumption During Laparoscopic Abdominal Surgery: A Single-Center Retrospective Analysis (腹腔鏡下腹部手術における筋弛緩モニター使用の有無とロクロニウム投与量の関連性を調べた研究:単一施設後ろ向き研究)
Full text linkBackground Rocuronium consumption with or without intraoperative objective neuromuscular monitoring in clinical settings of unrestricted use of sugammadex and neuromuscular monitoring has not been reported earlier. The study aimed to investigate the association between the use of intraoperative objective neuromuscular monitoring and rocuronium consumption in patients undergoing laparoscopic abdominal surgery. Methods Data were collected by reviewing electronic medical records of patients who received laparoscopic abdominal surgery under general anesthesia with rocuronium and reversal with sugammadex at a university teaching hospital between May 2017 and April 2018. A multivariate linear regression model was developed to compare the amount of rocuronium consumption (mg) per weight (kg) per hour (mg/kg/h) between the group in which intraoperative objective neuromuscular monitoring was used (NMM+ group) and the group in which intraoperative neuromuscular monitoring was not used (NMM- group). Additionally, we performed an interaction test. Results A total of 429 patients were evaluated, with 371 patients (86%) included in the NMM+ group and 58 patients (14%) in the NMM- group. Log-transformed rocuronium consumption between the NMM+ group and NMM- group was not significantly different (back-transformed β coefficients [95% CI]: 1.080 [0.951-1.226]; P = 0.23). Male sex and body mass index (BMI) were independent factors associated with 15% (0.853 [0.788-0.924]; P < 0.001) and 3% (for every 1 kg/m2 increase in BMI) (0.971 [0.963-0.979]; P < 0.001) decrease in intraoperative rocuronium consumption, respectively. A significant interaction was detected only between the use of neuromuscular monitoring and age ≥65 years (β: 0.803 [0.662-0.974]; P = 0.026). Conclusions Although the use of intraoperative objective neuromuscular monitoring was not an individual factor influencing intraoperative rocuronium consumption, this retrospective study demonstrated that the use of intraoperative neuromuscular monitoring reduced rocuronium consumption for approximately 20% of elderly patients (age ≥65 years) undergoing laparoscopic abdominal surgery.博士（医学）旭川医科大
