7．心血管作動薬・血圧管理—周術期低血圧への対応

Inotropes and vasopressors to treat perioperative hypotension

麻酔管理中には，麻酔薬，手術操作，患者因子などさまざまな要因により，血圧低下が生じる。血圧低下が生じた場合には，その原因を把握したうえで血管作動薬や輸液管理により，適正血圧へと回復させる必要がある。近年，周術期血圧低下が術後臓器傷害発生率や死亡率と関連することを示す研究が数多く報告され，周術期血圧管理の重要性が改めて脚光を浴びている。本稿では，周術期低血圧が予後に及ぼす影響に関する最近の知見を紹介し，適正血圧を維持するために使用される心血管作動薬に焦点を当て，エビデンスに基づく実践的使用方法について述べる。

Anesthetic agents, surgical procedures and complications in surgical patients can induce perioperative hypotension. Anesthesiologists are required to preserve appropriate hemodynamics with inotropes, vasopressors and fluid management during the perioperative period. Many recent studies have demonstrated that perioperative hypotension is associated with greater postoperative morbidity including myocardial injury, acute kidney injury, and mortality. This has led to a renewal of interest in the clinical significance of perioperative hemodynamic management. In this paper, the author describes recent evidence regarding the association between perioperative hemodynamics and prognosis and suggests strategies to deal with perioperative hypotension using inotropes and vasopressors in the perioperative period.