アルコール性肝硬変患者の乳がん手術に対する胸部傍脊椎ブロック併用のレミマゾラムを用いた全身麻酔の経験

General Anesthesia with Remimazolam Coupled with Thoracic Paravertebral Block for a Patient with Alcoholic Liver Cirrhosis Undergoing Breast Cancer Surgery：A Case Report

要旨

　アルコール性肝硬変患者の乳がん手術の麻酔管理をレミマゾラム全静脈麻酔＋胸部傍脊椎ブロックで行った。レミマゾラム効果遷延の可能性があったが，bispectral index（BIS）モニターに基づく用量調整により低用量のレミマゾラム（手術中平均0.02mg・kg^－1・hr^－1）で麻酔維持可能で，術中記憶なく，覚醒遅延や術後せん妄を起こすことなく管理できた。

　Patients with liver cirrhosis are at an increased risk of perioperative morbidity including delayed emergence from general anesthesia and postoperative neurocognitive complications. In patients with liver dysfunction, the effect of remimazolam, a short-acting benzodiazepine, is prolonged due to its impaired metabolism. We describe the case of a 75-year-old female with alcoholic liver cirrhosis（Child-Pugh B）who underwent breast cancer surgery under total intravenous anesthesia with remimazolam coupled with a thoracic paravertebral block. Since an adequate anesthesia depth was possible at a very low dose of remimazolam during the surgical procedure（average 0.02 mg・kg^－1・h^－1）by adjusting its dose based on the output of a BIS monitor, the patient recovered uneventfully without delayed awakening, intraoperative memory, or postoperative delirium.