心不全を合併した乳児神経芽腫摘出術の麻酔経験

Anesthetic Management of a 7-Month-old Infant with Neuroblastoma and Heart Failure

要旨

　高血圧・頻脈・うっ血性心不全を合併した7カ月，男児の腹部神経芽腫に対する摘出手術の麻酔を経験した。術前に降圧薬と利尿薬で心不全を改善した。術中は高血圧に対してニカルジピンで降圧を図った。輸液過多を防ぐため赤血球輸血を併用し，中心静脈圧，尿量，乳酸値を指標に輸液量を制限した。児は合併症なく退院した。

　We report the anesthetic management of a 7-month-old infant with neuroblastoma and heart failure. During the patient’s assessment, the symptoms of heart failure were exacerbated；therefore, enalapril and furosemide administration was started. In the intraoperative period, hemodynamic changes were minimized successfully by maintaining appropriate anesthesia depth and administering intravenous nicardipine. Furthermore, the amount of intraoperative fluid was restricted to 11 ml・kg⁻¹・hr⁻¹, which was lower than that used in common abdominal surgeries in infants. The patient was discharged 9 days after the surgery without any recurrence of heart failure. Finally, pathophysiological diagnosis of neuroblastoma was confirmed.