当院手術室におけるwide QRS頻拍に対する初期対応フローチャートの紹介

Initial Response Flowchart Used in Operating Room for Wide QRS Tachycardia

要旨

　術中に生じるwide QRS頻拍に対する迅速な初期対応は容易ではない。手術の状況によっては，12誘導心電図の記録や除細動/カルディオバージョンをただちに施行できないためである。迅速な対応には，術中の限られた状況でのwide QRS頻拍の鑑別と制限のある初期対応の整理および簡略化が必要である。そこで，手術中の特殊性を考慮した，成人を対象とする初期対応フローチャートを当院で作成したので紹介する。

　Intraoperative wide QRS tachycardia can disrupt the patient’s hemodynamics and requires immediate attention. A wide QRS tachycardia may be due to ventricular arrhythmias or supraventricular arrhythmias, and determining the origin of the arrhythmia is challenging using only a 12-lead electrocardiogram. An initial response flowchart was created for anesthesiologists to determine how to treat intraoperative wide QRS tachycardia. This flowchart classifies wide QRS tachycardia into four categories, simplifies the differentiation process, and combines the differentiation and initial treatment steps. In addition, recommendations are provided in case when the wide QRS tachycardia category cannot be determined. The flowchart specifies whether an antiarrhythmic drug should be administered or defibrillation/cardioversion should be conducted depending on the situation of surgery. The flowchart assumes an initial response will be performed within 30 minutes of the first wide QRS tachycardia. The use of this flowchart can help anesthesiologists determine the initial treatment of intraoperative wide QRS tachycardia.