麻酔科プラクティス 3 麻酔科医に必要な周術期呼吸管理

出版社: 文光堂
著者:
発行日: 2020-12-04
分野: 臨床医学:外科  >  麻酔科学/ペイン
ISBN: 9784830628498
電子書籍版: 2020-12-04 (第1版第1刷)
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〈麻酔科プラクティス〉シリーズ第3巻は,術中の麻酔管理に重要な「呼吸管理」について必要な最新知識を解説.近年,人工呼吸器の性能は飛躍的に向上し,様々なモニタリング機能やモードが追加された.便利になった反面,本来の適切な設定方法で見るべきポイントが忘れられてきている.本書では,呼吸管理に苦手意識を持つ麻酔科医や若手麻酔科医でも適切に理解して呼吸管理ができるよう,必ず押さえておきたい情報を厳選解説.人工呼吸器,気道確保デバイスを理解して使えるようになる.呼吸管理の最新の考えかた,人工呼吸器のモードや画面の見かた,術前評価のポイントがわかる.また,本書に満載,最前線で臨床に携わる麻酔科医によるアドバイス「Clinical Pearls」は必ず実践で役立つはず.

目次

  • I 呼吸生理の基礎
     1 麻酔科専門医に必要な呼吸生理の知識

    II 術前評価
     1 身体所見の見かた
     2 胸部X線検査の見かた
     3 呼吸機能検査の読みかた
     4 動脈血液ガス分析

    III 気道確保
     1 喉頭展開デバイス
     2 気道確保デバイス
     3 困難気道の対応
     4 観血的気道確保の方法

    IV 酸素療法
     1 酸素療法の基本
     2 HFNC,NPPV

    V 呼吸器デバイスの基本構造
     1 麻酔器の基本構造
     2 麻酔用人工呼吸器の基本構造
     [T]最近の麻酔器と低流量麻酔支援機能

    VI 医療ガスの基礎知識
     1 医療ガスの種類

    VII 人工呼吸モード
     1 PCVとVCV
     2 基本的な換気モードA/C
     3 基本的な換気モードSIMV
     4 基本的な換気モードPSV
     5 特殊なモード
     6 ECMOの基本コンセプト
     7 NO吸入療法

    VIII 人工呼吸器管理の考えかた
     1 肺保護換気
     2 自発呼吸 VS 陽圧換気 利点と欠点
     [OPA]食道内圧と経肺圧
     3 術中呼吸管理の考えかた
     4 換気設定
     [B]PEEPの設定方法
     5 抜管の基準
     6 離脱に難渋する患者の離脱戦略
     7 加温加湿,人工鼻
     8 小児の人工呼吸器管理
     9 人工呼吸中のモニタリング
     10 グラフィックモニター
     11 コンプライアンスとレジスタンス
     [OPA]CO2モニタリングの重要性―monitored anesthesia care―
     12 人工呼吸と肺エコー
     [T]electrical impedance tomography(EIT)

    IX 合併疾患を有する患者の術中管理
     1 慢性閉塞性肺疾患,気管支喘息
     2 間質性肺炎
     3 肥満,睡眠時無呼吸症候群
     [OPA]筋萎縮性側索硬化症(ALS)患者の胃瘻造設管理


    X 手術と呼吸管理 各論
     1 腹腔鏡手術の呼吸管理
     2 呼吸器外科手術の呼吸管理
     3 母体の周術期呼吸管理

    XI 合併症とその管理
     1 無気肺,気胸・血胸,誤嚥性肺

    XII 呼吸器関連リハビリテーション
     1 術前呼吸訓練
     2 術後リハビリテーション

    [T]=Topics
    [B]=Basic
    [OPA]=One Point Advice

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

I 呼吸生理の基礎

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II 術前評価

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III 気道確保

P.39 掲載の参考文献
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6) Asai T, et al : Difficulty in advancing a tracheal tube over a fibreoptic bronchoscope : incidence, causes and solutions. Br J Anaesth 92 : 870-881, 2004
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8) Pujol E, et al : Use of the Ambu(R) aScope(TM) in 10 patients with predicted difficult intubation. Anaesthesia 65 : 1037-1040, 2010
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4) Chastre J, et al : Ventilator-associated pneumonia. Am J Respir Crit Care Med 165 : 867-903, 2002
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6) Muscedere J, et al : Subglottic secretion drainage for the prevention of ventilator-associated pneumonia : a systematic review and meta-analysis. Crit Care Med 39 : 1985-1991, 2011
7) 浦野博秀ほか : スパイラルチューブの易閉塞性. 日手術医会誌 17 : 120-124, 1996
8) 位田みつるほか : 甲状腺左葉切除術中にスパイラルチューブの内腔狭窄により換気困難となった1症例. 麻酔 63 : 1128-1130, 2014
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10) 保富宗城ほか : 甲状腺・副甲状腺外科手術における術中神経モニタリング. 耳鼻臨床 107 : 272-273, 2014
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2) 浅井隆 : 観血的気管挿管困難の予測法. Dr. あさいのみんなの気道確保 第2巻 気道確保のエキスパートとなろう!, 中外医学社, 東京, 15-16, 2016
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IV 酸素療法

P.59 掲載の参考文献
1) 日本呼吸ケア・リハビリテーション学会, 日本呼吸器学会 : 酸素療法マニュアル, メディカルレビュー社, 東京, 2017
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4) Judson SD, et al : Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 11 : 940, 2019
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1) 日本呼吸ケア・リハビリテーション学会, 日本呼吸器学会 : 酸素療法マニュアル, メディカルレビュー社, 東京, 2017
2) Helviz Y, et al : A systematic review of the high-flow nasal cannula for adult patients. Crit Care 22 : 71, 2018
3) Motoyasu A, et al : Oxygen at a high flow rate (35 L・min-1) via face mask for preoxygenation. Can J Anaesth 61 : 207-208, 2014
4) 木山秀哉 : Apnoeic. 臨麻 43 : 1359-1366, 2019
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8) Agarwal A, et al : High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19 : systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth 67 : 1217-1248, 2020

V 呼吸器デバイスの基本構造

P.69 掲載の参考文献
1) Sulbaek Andersen MP, et al : Atmospheric chemistry of isoflurane, desflurane, and sevoflurane : kinetics and mechanisms of reactions with chlorine atoms and OH radicals and global warming potentials. J Phys Chem A 116 : 5806-5820, 2012
2) Ishizawa Y : Special article : general anesthetic gases and the global environment. Anesth Analg 112 : 213-217, 2011
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1) Jain RK, et al : Anaesthesia ventilators. Indian J Anaesth 57 : 525-532, 2013
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3) Wirth S, et al : Application of the novel ventilation mode fLow-controlled expiration (FLEX) : A crossover proof-of-principle study in lung-healthy patients. Anesth Analg 125 : 1246-1252, 2017
4) Schmidt J, et al : Flow-controlled ventilation during ear, nose and throat surgery : A prospective observational study. Eur J Anaesthesiol 36 : 327-334, 2019
5) Barnes T, et al : Minimisation of dissipated energy in the airways during mechanical ventilation by using constant inspiratory and expiratory flows-Flow-controlled ventilation (FCV). Med Hypotheses 121 : 167-176, 2018
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1) Avidan MS, et al : Prevention of intraoperative awareness with explicit recall : making sense of the evidence. Anesthesiology 118 : 449-456, 2013

VI 医療ガスの基礎知識

P.85 掲載の参考文献
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VII 人工呼吸モード

P.91 掲載の参考文献
1) 一般社団法人日本呼吸療法医学会専門医委員会 : 呼吸療法専門医テキスト 2019, 一般社団法人日本呼吸療法医学会専門医委員会, 東京, 45-46, 2019
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3) Qvist J, et al : Hemodynamic responses to mechanical ventilation with PEEP : the effect of hyper volemia. Anesthesiology 42 : 45-55, 1975
4) Devlin JW, et al : Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 46 : e825-e873, 2018
5) Benedicte T, et al : Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in intubated ICU patients. Intensive Care Medicine 33 : 1148-1154, 2017
P.100 掲載の参考文献
1) 讃井將満ほか : 簡単アンケート 第20弾 : 人工呼吸器の設定と離脱, 2012
2) Kohara J, et al : Derivation and validation of an equation to determine the optimal ventilator setting in children undergoing intracranial revascularization surgery : a single-center retrospective study. Pediatric Anesthesia 30 : 1, 2019
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IX 合併疾患を有する患者の術中管理

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5) Jaber S, et al : A multicentre observational study of intra-operative ventilatory management during general anaesthesia : tidal volumes and relation to body weight. Anaesthesia 67 : 999-1008, 2012
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X 手術と呼吸管理 各論

P.223 掲載の参考文献
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6) Eichacker PQ, et al : Meta-analysis of acute lung injury and acute respiratory distress syndrome trials testing low tidal volumes. Am J Respir Crit Care Med 166 : 1510-1514, 2002
7) Licker M, et al : Impact of intraoperative lung-protective interventions in patients undergoing lung cancer surgery. Crit Care 13 : R41, 2009
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17) Roze H, et al : Pressure-controlled ventilation and intrabronchial pressure during one-lung ventilation. Br J Anaesth 105 : 377-381, 2010
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3) Leboulanger N, et al : Pregnancy is associated with a decrease in pharyngeal but not tracheal or laryngeal cross-sectional area : a pilot study using the acoustic reflection method. Int J Obstet Anesth 23 : 35-39, 2014
4) Ali Z, et al : Incidence and risk factors for exacerbations of asthma during pregnancy. J Asthma Allergy 6 : 53-60, 2013
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11) Paranjothy S, et al : Interventions at caesarean section for reducing the risk of aspiration pneumonitis. Cochrane Database Syst Rev (2) : CD004943, 2014
12) Shippam W, et al : High-flow nasal oxygen vs. standard flow-rate facemask pre-oxygenation in pregnant patients : a randomised physiological study. Anaesthesia 74 : 450-456, 2019
13) Toker MK, et al : Comparison of the McGrath video laryngoscope and macintosh direct laryngoscope in obstetric patients : A randomized controlled trial. Pak J Med Sci 35 : 342-347, 2019
14) Yao WY, et al : Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section : a randomized controlled trial. BMC Anesthesiol 19 : 123, 2019
15) Fujita N, et al : Nocturnal desaturation early after delivery : impact of delivery type and the beneficial effects of Fowler's position. Br J Anaesth 122 : e64-e66, 2019

XI 合併症とその管理

P.243 掲載の参考文献
1) Duggan M, et al : Pulmonary atelectasis. Anesthesiology 102 : 838-854, 2005
3) Neto AS, et al : Association between driving pressure and development of postoperative complication in patients undergoing mechanical ventilation for general anaesthesia : a meta-analysis of individual patient data. Lancet Respir Med 4 : 272-280, 2016
4) Tusman G, et al : Alveolar recruitment during mechanical ventilation-Where are we in 2013? Trends in Anesthesia and Critical Care 3 : 238-245, 2013
5) 小谷透 : 肺胞リクルートメント. 人工呼吸. Jpn Repir Care 36 : 144-150, 2019
6) Ding W, et al : Diagnosis of pneumothorax by radiography and ultrasonography. Chest 140 : 859-866, 2011
7) Zhou J, et al : External suction versus simple water-seal on chest drainage following pulmonary surgery : an updated meta-analysis. Interact Cardiovasc Thorac Surg 28 : 29-36, 2019
8) 日本呼吸器学会成人肺炎診療ガイドライン2017作成委員会編 : 成人肺炎診療ガイドライン 2017, 日本呼吸器学会 (代表) 橋本 修発行, 一般社団法人日本呼吸器学会, 日本メディカルレビュー社, 東京, 39, 2017
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10) 斎藤朋之 : 周術期誤嚥性肺炎の危険因子-麻酔因子, 手術因子-. 麻酔 65 : 29-36, 2016

XII 呼吸器関連リハビリテーション

P.251 掲載の参考文献
1) 日本集中治療医学会早期リハビリテーション検討委員会 : 集中治療における早期リハビリテーション~根拠に基づくエキスパートコンセンサス~. 日集中医誌 24 : 255-303, 2017

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