下顎骨骨折を誘因として発症したと考えられるたこつぼ型心筋症患者の周術期管理の1例

DOI
  • 尾﨑 貴子
    東海大学医学部医学科外科学系麻酔科 岩手医科大学歯学部口腔顎顔面再建学講座歯科麻酔学分野
  • 伊藤 健二
    東海大学医学部医学科外科学系麻酔科
  • 佐藤 健一
    岩手医科大学歯学部口腔顎顔面再建学講座歯科麻酔学分野
  • 鈴木 武志
    東海大学医学部医学科外科学系麻酔科

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  • Perioperative Management of a Patient with Takotsubo Cardiomyopathy Induced by a Mandibular Fracture

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<p>  A patient with takotsubo cardiomyopathy (TCM) underwent an open reduction and internal fixation under general anesthesia for a mandibular fracture. The patient had no history of cardiac disease, and TCM was thought to have been triggered by a fracture of the articular process of the mandible. Although the exact causes of TCM are not fully elucidated, it is known to be a stress-induced cardiomyopathy. The prevalence of TCM is high among postmenopausal women. The patient presented with no characteristic chest symptoms on admission to the hospital. However, she was diagnosed as having TCM according to the Mayo Clinic criteria. Since no specific treatment for TCM exists, it is important to avoid stress to prevent deteriorating symptoms. During surgery, her heart rate was controlled to avoid tachycardia and adequate intravascular volume was maintained using the FloTrac System, which enables the evaluation of stroke volume variations and invasive arterial blood pressure measurements. The use of sevoflurane and remifentanil hydrochloride, both of which have low cardiac depression effects and are easily adjustable, ensured good anesthetic management. The patient was carefully monitored and managed during the perioperative period to avoid the recurrence of TCM.</p>

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