タンパク漏出性胃腸症による高度低タンパク血症と全身性浮腫を伴う患者のレミマゾラムを用いた全身麻酔の経験

General Anesthesia using Remimazolam in a Patient with Severe Hypoproteinemia and Generalized Edema due to Protein-losing Enteropathy：A Case Report

要旨

　タンパク漏出性胃腸症による高度低タンパク血症と全身性浮腫を伴う患者のロボット支援下胃全摘術をレミマゾラム全身麻酔＋区域麻酔で管理した。低タンパク血症による血中遊離型薬物濃度上昇と全身性浮腫による分布容積変化のために，薬物用量過剰の可能性があったが，用量調整により重大有害事象を引き起こすことなく管理できた。

　A 47-year-old overweight male（BMI 36.0）with hypoproteinemia（plasma total protein, 3.3 g・dl^－1；albumin, 1.4 g・dl^－1）and generalized edema due to protein-losing enteropathy caused by gastric cancer and polyposis underwent a robotic total gastrectomy under general anesthesia with remimazolam coupled with a rectus sheath and subcostal transversus abdominus plane blocks using ropivacaine. It is possible that（ⅰ）in patients with hypoproteinemia, the effects of highly plasma protein-bound drugs are enhanced due to an increased free/unbound drug concentration, and that（ⅱ）in patients with generalized edema the effects of water-soluble drugs may vary significantly due to distribution volume changes. Our patient’s case was managed without adverse effects（e.g., delayed emergence and local anesthetic toxicity）by adjusting the doses of remimazolam and ropivacaine.