経尿道的前立腺切除術時の麻酔法—硬膜外麻酔法の一工夫

ANESTHESIOLOGICAL METHOD IN TUR-P: ONE TRIAL IN EPIDURAL ANESTHESIA

緒言

　経尿道的前立腺切除術対象患者は，疾患の性質上高齢者が多く，同時に約半数に心電図異常，高血圧，虚血性心疾患などの循環器系合併症を有する^1〜3）という点で麻酔管理上種々の問題点を含んでいる。よく行われる麻酔法としては全身麻酔，脊椎麻酔，硬膜外麻酔などがあり，それぞれ一長一短があるが^1〜3,7），われわれは主として硬膜外麻酔法を用いており，その方法に関し若干の工夫を加えたのでこれを報告する。

The patients who are candidates for TUR-P are usually old and about half of them have cardio-vascular complications such as hypertension, abnormal ECG or ischemic heart disease. In our series 73% of 38 cases had some such complications. Epidural anesthesia was usually performed in TUR-P at our institution, and we often experienced hypotensive episodes about 15-20 minutes after the injec-tion of local analgesics through the epidural catheter inserted foward the cephalic direction. This phenomenon can be explained by the block of sympathetic nerves in large extent.