高齢者麻酔のポイント50

出版社： 克誠堂出版
著者：
発行日： 2021-06-06
分野： 臨床医学：外科  >  麻酔科学/ペイン
ISBN： 9784771905504
電子書籍版： 2021-06-06 （第1版第1刷）
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高齢者の定義は？ どの麻酔薬の選択が望ましい？ 高齢者に多い術後合併症とは？ 高齢者にかかわる麻酔科医に向けて、高齢患者の周術期全身管理についての臨床疑問５０をＱ＆Ａ形式でわかりやすく解説する。

目次

  • Q1　高齢者の定義を教えてください。
    Q2　高齢者総合機能評価について教えてください。
    Q3　高齢者の術前検査の評価について注意点を教えてください。
    Q4　高齢者に多い内服薬とその術前管理について教えてください。
    Q5　周術期の注意すべき薬物、その管理法を教えてください。
    Q6　サルコペニアとその診断法を教えてください。
    Q7　フレイルとは何ですか？　評価法も教えてください。
    Q8　プレハビリテーションとは何ですか？
    Q9　周術期の呼吸リハビリテーションについて教えてください。
    Q10　術前の栄養評価法を教えてください。
    Q11　周術期の栄養管理法について教えてください。
    Q12　周術期の口腔ケアについて教えてください。
    Q13　術前の禁煙について教えてください。
    Q14　術前の絶飲食について教えてください。
    Q15　若年・壮年と比べた高齢者の薬物動態・薬力学の特徴について教えてください。
    Q16　術前にオピオイドを使用している患者の周術期オピオイド管理について教えてください。　
    Q17　周術期抗菌薬投与とは？　高齢者における注意点は？
    Q18　高齢者ではどの麻酔薬の選択が望ましいのか教えてください。
    Q19　高齢者の処置時の鎮静について教えてください。
    Q20　術中に脳波モニターで麻酔深度をモニターすべきですか？
    ほか

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。

Q1 高齢者の定義を教えてください。

P.3 掲載の参考文献
1) https://www.who.int/healthinfo/survey/ageingdefnolder/en/ (2020年6月15日閲覧)
 
2) https://www.who.int/ageing/en/ (2020年6月15日閲覧)
 
3) 高齢者の医療の確保に関する法律 (昭和五十七年法律第八十号)
 
4) 荒井秀典. 高齢者の定義について. 日老医誌 2019 ; 56 : 1-5.
 
5) 日本老年医学会, 日本老年学会, 編. 高齢者に関する定義ワーキンググループ報告書. https://www.jpn-geriat-soc.or.jp/info/topics/pdf/20170410_01_01.pdf (2021年3月18日閲覧)
 
6) Berger M, Acker L, Deiner S. Geriatric Anesthesia. In : Gropper MA, editor-in-chief. Miller's Anesthesia. Vol 2. 9th ed. New York : Churchill Livingstone ; 2020. p.2102-14.
 

Q2 高齢者総合機能評価について教えてください。

P.6 掲載の参考文献
1) 西永正典. 総合機能評価 (CGA) の臨床応用とその意義. 日老医誌 2000 ; 37 : 859-65.
 
2) 長寿科学総合研究CGAガイドライン研究班. CGAガイドライン研究班推奨アセスメントセット. 鳥羽研二, 監. 高齢者総合機能評価ガイドライン. 東京 : 厚生科学研究所 ; 2003. p.14-5.
 
3) 日本老年医学会. 高齢者診療におけるお役立ちツール. https://jpn-geriat-soc.or.jp/tool/index.html (2020年5月10日閲覧)
 
4) 長寿科学総合研究CGAガイドライン研究班. CGA利用の効果. 鳥羽研二監修. 高齢者総合機能評価ガイドライン. 東京 : 厚生科学研究所 ; 2003. p.32-69.
 
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7) Comprehensive geriatric assessment is a useful predictive tool for postoperative delirium sfter gastrointestinal surgery in old-old adults. Geriatr Gerontol Int 2016 ; 16 : 1036-42.
 
8) Eamer G, Saravana-Bawan B, van der Westhuizen B, et al. Economic evaluations of comprehensive assessment in surgical patients : a systematic review. J Surg Res 2017 ; 218 : 9-17.
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Q3 高齢者の術前検査の評価について注意点を教えてください。

P.10 掲載の参考文献
1) 野口善令. 凝固系検査. 野口善令, 編. 診断に自信がつく検査値の読み方教えます. 東京 : 羊土社 ; 2015. p.74-80.
 
2) 吉田紗衣子. 甲状腺機能. 野口善令, 編. 診断に自信がつく検査値の読み方教えます. 東京 : 羊土社 ; 2015. p.169-82.
 
3) 橋本和弘, 志水秀行, 工藤樹彦, ほか. 弁膜疾患・不整脈疾患. 龍野勝彦, ほか編. 心臓血管外科テキスト (改定2版). 東京 : 中外医学社 ; 2011. p.307-33.
 
4) 廣瀬宗孝. 高齢者の術前検査とその評価. 澄川耕二, 編. 高齢者の周術期管理. 東京 : 克誠堂出版 ; 2014. p.68-78.
 
5) 恒吉勇男. 腎合併症と水代謝異常. 稲垣喜三, 編. 術前評価と予測因子からみた周術期合併症対策. 東京 : 克誠堂出版 ; 2016. p.68-78.
 

Q4 高齢者に多い内服薬とその術前管理について教えてください。

P.16 掲載の参考文献
1) 高齢者の安全な薬物療法ガイドライン 2015. 日本老年医学会/日本医療研究開発機構研究費「高齢者の薬物治療の安全性に関する研究」研究班編集. 日本老年医学会発行, 東京, 2015.
 
2) 高齢者の医薬品適正使用の指針 (総論編). 厚生労働省. 2018年5月. https://www.mhlw.go.jp/content/11121000/koureitekisei_web.pdf (2021年3月9日閲覧)
 

Q5 周術期の注意すべき薬物, その管理法を教えてください。

P.19 掲載の参考文献
1) Sieber F, Pauldine R. Geriatric Anesthesia. In : Miller RD, editor. Miller's anesthesia. Vol. 2.8th ed. Philadelphia : Saunders ; 2015. p.2407-22.
 
2) Matteo RS, Ornstein E, Schwartz AE, et al. Pharmacokinetics and pharmacodynamics of rocuronium (Org 9426) in elderly surgical patients. Anesth Analg 1993 ; 77 : 1193-7.
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3) McDonagh DL, Benedict PE, Kovac AL, et al. Efficacy, safety, and pharmacokinetics of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in elderly patients. Anesthesiology 2011 ; 114 : 318-29.
PubMed

Q6 サルコペニアとその診断法を教えてください。

P.23 掲載の参考文献
1) Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia : revised European consensus on definition and diagnosis. Age Ageing 2019 ; 48 : 16-31.
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2) Hua H, Xu X, Tang Y, et al. Effect of sarcopenia on clinical outcomes following digestive carcinoma surgery : a meta-analysis. Support Care Cancer 2019 ; 27 : 2385-94.
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3) Fujishima I, Fujiu-Kurachi M, Arai H, et al. Sarcopenia and dysphagia : Position paper by four professional organizations. Geriatr Gerontol Int 2019 ; 19 : 91-7.
 
4) Wakabayashi H. Rehabilitation nutrition in general and family medicine. J Gen Fam Med 2017 ; 18 : 153-4.
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5) Nagano A, Nishioka S, Wakabayashi H. Rehabilitation Nutrition for Iatrogenic Sarcopenia and Sarcopenic Dysphagia. J Nutr Health Aging 2019 ; 23 : 256-65.
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6) Martone AM, Bianchi L, Abete P, et al. The incidence of sarcopenia among hospitalized older patients : results from the Glisten study. J Cachexia Sarcopenia Muscle 2017 ; 8 : 907-14.
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7) Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia : 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc 2020 ; 21 : 300-7.e2.
 
8) Malmstrom TK, Morley JE. SARC-F : a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc 2013 ; 14 : 531-2.
 
9) Papadopoulou SK, Tsintavis P, Potsaki P, et al. Differences in the Prevalence of Sarcopenia in Community-Dwelling, Nursing Home and Hospitalized Individuals. A Systematic Review and Meta-Analysis. J Nutr Health Aging 2020 ; 24 : 83-90.
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10) Churilov I, Churilov L, MacIsaac RJ, et al. Systematic review and meta-analysis of prevalence of sarcopenia in post acute inpatient rehabilitation. Osteoporos Int 2018 ; 29 : 805-12.
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Q7 フレイルとは何ですか ? 評価法も教えてください。

P.29 掲載の参考文献
1) 後期高齢者の保健事業のあり方に関する研究. https://www.mhlw.go.jp/file/05-Shingikai-12601000-Seisakutoukatsukan-Sanjikanshitsu_Shakaihoshoutantou/0000125471.pdf (2020年1月28日閲覧)
 
2) Morley JE, Vellas B, van Kan GA, et al. Frailty consensus : a call to action. J Am Med Dir Assoc 2013 ; 14 : 392-7.
 
3) フレイル診療ガイド. http://jssf.umin.jp/clinical_guide.html (2020年1月28日閲覧)
 
4) オーラルフレイル. https://www.jda.or.jp/dentist/oral_flail/pdf/manual_sec_01.pdf (2020年1月28日閲覧)
 
5) Richards SJG, Frizelle FA, Geddes JA, et al. Frailty in surgical patients. Int J Colorectal Dis 2018 ; 33 : 1657-66.
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6) Satake S, Shimada H, Yamada M, et al. Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria. Geriatr Gerontol Int 2017 ; 17 : 2629-34.
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7) Kojima G, Iliffe S, Taniguchi Y, et al. Prevalence of frailty in Japan : A systematic review and meta-analysis. J Epidemiol 2017 ; 27 : 347-53.
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8) Dhesi JK, Lees NP, Partridge JS. Frailty in the perioperative setting. Clin Med (Lond). 2019 ; 19 : 485-9.
 
9) Yanagawa B, Graham MM, Afilalo J, et al. Frailty as a risk predictor in cardiac surgery : Beyond the eyeball test. J Thorac Cardiovasc Surg 2018 ; 156 : 172-6.
 

Q8 プレハビリテーションとは何ですか ?

P.33 掲載の参考文献
1) Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery : a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005 ; 24 : 466-77.
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2) Lachmann G, Morgeli R, Kuenz S, et al. Perioperatively acquired weakness. Anesth Analg 2020 ; 130 : 341-51.
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3) Shinall MC Jr, Arya S, Youk A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA surgery 2019 : e194620.
 
4) Levett DZ, Edwards M, Grocott M, et al. Preparing the patient for surgery to improve outcomes. Best Pract Res Clin Anaesthesiol 2016 ; 30 : 145-57.
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5) Physical Activity and Older Adults Recommended levels of physical activity for adults aged 65 and above. https://www.who.int/dietphysicalactivity/factsheet_olderadults/en/ (2021年3月8日閲覧)
 
6) Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention : reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2012 ; 62 : 30-67.
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7) Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation : a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology 2014 ; 121 : 937-47.
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8) Barberan-Garcia A, Ubre M, Pascual-Argente N, et al. Post-discharge impact and cost-consequence analysis of prehabilitation in high-risk patients undergoing major abdominal surgery : secondary results from a randomised controlled trial. Br J Anaesth 2019 ; 123 : 450-6.
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9) Katsura M, Kuriyama A, Takeshima T, et al. Preoperative inspiratory muscle training for postoperative pulmonary complications in adults undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev 2015 ; 10 : CD010356.
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10) Heger P, Probst P, Wiskemann J, et al. A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg 2019 Jun 21. doi : 10.1007/s11605-019-04287-w.
 
11) Thomas G, Tahir MR, Bongers BC, et al. Prehabilitation before major intra-abdominal cancer surgery : A systematic review of randomised controlled trials. Eur J Anaesthesiol 2019 ; 36 : 933-45.
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12) Gometz A, Maislen D, Youtz C, et al. The effectiveness of prehabilitation (prehab) in both functional and economic outcomes following spinal surgery : A systematic review. Cureus 2018 ; 10 : e2675. doi : 10.7759/cureus.2675.
 
13) Moyer R, Ikert K, Long K, et al. The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty : A systematic review and meta-analysis. JBJS Rev 2017 ; 5 : e2. doi : 10.2106/JBJS.RVW.17.00015.
 
14) Janssen TL, Steyerberg EW, Langenberg JCM, et al. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery : An uncontrolled before-and-after study. PLoS One 2019 ; 14 : e0218152.
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15) Schier R, Levett D, Riedel B. Prehabilitation : The next challenge for anaesthesia teams. Eur J Anaesthesiol 2020 ; 37 : 259-62.
PubMed

Q9 周術期の呼吸リハビリテーションについて教えてください。

P.38 掲載の参考文献
1) 公益社団法人日本リハビリテーション医学会監修. 安静臥床時の臨床生理. リハビリテーション医学・医療コアテキスト. 39. 東京 : 医学書院 ; 2018.
 
2) Nakagawa M, Tanaka H, Tsukuma H, et al. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest 2001 ; 120 : 705-10.
PubMed
3) Vaporciyan AA, Merriman KW, Ece F, et al. Incidence of major pulmonary morbidity after pneumonectomy : association with timing of smoking cessation. Ann Thorac Surg 2002 ; 73 : 420-5.
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4) 小池有美, 岩橋誠, 中森幹人, ほか. 胸部食道癌患者に対する術前心肺機能強化トレーニング効果に関する前向き研究. 日消外会誌 2010 ; 43 : 487-94.
 
5) Licker M, karenovics W, Diaper J, et al. Short-term preoperative high-intensity interval training in patients awaiting lung cancer surgery : A randomized controlled trial. J Surg Res 2017 ; 12 : 323-33.
 
6) Nakamura M, Iwahashi M, Nakamori M, et al. An analysis of the factors contributing to a reduction in the incidence of pulmonary complications following an esophagectomy for esopageal cancer. Langenbecks Arch Surg 2008 ; 393 : 127-33.
 
7) Lai Y, Huang J, Yang M, et al. Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer : A randomized controlled trial. J Surg Res 2017 ; 209 : 30-6.
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8) 小山照幸, 羽生信義, 鈴木裕, ほか. 食道癌手術例に対する術前理学療法導入効果. 日臨外会誌. 2003 ; 64 : 305-9.
 

Q10 術前の栄養評価法を教えてください。

P.43 掲載の参考文献
1) Weimann A, Braga M, Carli F, et al. ESPEN guideline : Clinical nutrition in surgery. Clin Nutr 2017 ; 36 : 623-50.
 
2) Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition : Surgery. Clin. Nut 2009 ; 28 : 378-86.
 
3) Baker JP, Detsky AS, Whitwell J, et al. A comparison of the predictive value of nutritional assessment techniques. Hum Nutr Clin Nutr 1982 ; 36 : 233-41.
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4) Kondrup J, Allison SP, Elia M, et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003 ; 22 : 415-21.
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5) 小野寺時夫, Stage IV, V (Vは大腸癌) 消化器癌の非治療切除・姑息手術に対するTPN の適応と限界. 日本外科学会雑誌1984 ; 85 : 1001-5.
 

Q11 周術期の栄養管理法について教えてください。

P.48 掲載の参考文献
1) Weimann A, Braga M, Carli F, et al. ESPEN guideline : Clinical nutrition in surgery. Clin Nutr 2017 ; 36 : 623-50.
 
2) 谷口英喜. 麻酔科医に求められる周術期における栄養戦略-術前栄養評価から術後のDREAMを達成させるまで-. 日臨麻会誌 2017 : 37 ; 780-9.
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3) ASPEN Board of Directors. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN 1993 ; 17 : ISA-52SA.
 
4) McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient : Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr 2009 ; 33 : 277-315.
 
5) Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery : A consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005 ; 24 : 466-77.
PubMed
6) 日本麻酔科学会. 術前絶飲食ガイドライン. http://www.anesth.or.jp/news2012/pdf/20120712.pdf (2021年3月18日閲覧)
 
7) Smith I, Kranke P, Murat I, et al. European Society of Anaesthesiology. : Perioperative fasting in adults and children : guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol 2011 ; 28 : 556-69.
PubMed
8) Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery ; Laparoscopy and/or Fast track multimodal management versus standard care (LAFA trial). BMC Surg 2006 ; 6 : 16.
 

Q12 周術期の口腔ケアについて教えてください。

P.53 掲載の参考文献
1) 住友雅人. 日本歯科医学会が提案する新しい「口腔ケア」の概念. 日本歯科評論 2015 ; 75 : 10-1.
 
2) 縄稚久美子, 曽我賢彦, 山中玲子, ほか. 気管挿管における口腔内偶発症防止対策の必要性. 日集中医誌 2012 ; 19 : 431-2.
 
3) Sato J, Goto J, Harahashi A, et al. Oral health care reduces the risk of postoperative surgical site infection in inpatients with oral squamous cell carcinoma. Support Care Cancer 2011 ; 19 : 409-16.
 
4) Soutome S, Yanamoto S, Funahara M, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery : A multicenter case-control study with propensity score matching analysis. Medicine (Baltimore) 2017 ; 96 : e7436.
 
5) Takahashi-Arimasa K, Kohno-Yamanaka R, Soga Y, et al., Efficacy of oral care provided by interprofessional collaboration for a patient with esophageal cancer associated with post-polio syndrome during neoadjuvant chemotherapy. Acta Med Okayama 2019 ; 73 : 71-6.
PubMed
6) Akutsu Y, Matsubara H, Shuto K, et al., Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients. Surgery 2010 ; 147 : 497-502.
PubMed
7) 岡山大学病院周術期管理センター. http://okadaiperioperative.com/ (2021年1月26日閲覧)
 
8) Yamanaka R, Soga Y, Minakuchi M, et al., Occlusion and weight change in a patient after esophagectomy : success derived from restoration of occlusal support. Int J Prosthodont. 2013 ; 26 : 574-6.
 
9) Sura L, Madhavan A, Carnaby G, et al., Dysphagia in the Elderly : Management and Nutritional Considerations. Clin Interv Aging 2012 ; 7 : 287-98.
PubMed
10) Yamanaka-Kohno R, Shirakawa Y, Inoue-Minakuchi M, et al. Association of Dental Occlusal Support with the Prognostic Nutritional Index in Patients with Esophageal Cancer Who Underwent Esophagectomy. Esophagus 2021 : 18 ; 49-55.
PubMed

Q13 術前の禁煙について教えてください。

P.58 掲載の参考文献
1) A guideline for perioperative smoking cessation. J Anesth 2017 ; 31 : 297-303.
PubMed
2) Turan A, Mascha EJ, Roberman D, et al. Smoking and perioperative outcomes. Anesthesiology 2011 ; 114 : 837-46.
PubMed
3) Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications : a systematic review and meta-analysis. Am J Med 2011 ; 124 : 1 44-54. e8.
 
4) Wong J, Lam DP, Abrishami A, et al. Short-term preoperative smoking cessation and postoperative complications : a systematic review and meta-analysis. Can J Anaesth 2012 ; 59 : 268-79.
PubMed
5) Warner DO. Perioperative abstinence from cigarettes : physiologic and clinical consequences. Anesthesiology 2006 ; 104 : 356-67.
PubMed
6) Kito Y, Iida M, Tanabe K, et al. Smoking cessation affects human platelet activation induced by collagen. Exp Ther Med 2019 ; 18 : 3809-16.
PubMed
7) Dohi S, Iida M, Iida H, et al. Implementation of smoke-free policy in university hospital decreases carboxyhemoglobin level in inpatients undergoing surgery. Anesthesiology 2007 ; 106 : 406-7.
PubMed
8) Iida H, Iida M, Dohi S, et al. Preoperative smoking cessation and smoke-free policy in a university hospital in Japan. Can J Anaesth 2008 ; 55 : 316-8.
 
9) Shi Y, Warner DO. Surgery as a teachable moment for smoking cessation. Anesthesiology 2010 ; 112 : 102-7.
PubMed
10) Shi Y, Weingarten TN, Mantilla CB, et al. Smoking and pain : pathophysiology and clinical implications. Anesthesiology 2010 ; 113 : 977-92.
PubMed

Q14 術前の絶飲食について教えてください。

P.61 掲載の参考文献
1) Mohanty S. optimal perioperative management of the geriatric patient : a best practice guideline from the American college of surgeons nsqip and the American geriatrics society. J Am Coll Surg 2016 ; 222 : 930-47.
 
2) American college of surgeons NSQIP and the American geriatrics society https://www.facs.org/-/media/files/quality-programs/geriatric/acs-nsqip-geriatric-2016-guidelines.ashx?la=en (2021年3月8日閲覧)
 
3) American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration : application to healthy patients undergoing elective procedures : an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology. Mar 2011 ; 114 : 495-511.
PubMed
4) Robinson M. Aspiration under anaesthesia : risk assessment and decision-making. Continuing Education in Anaesthesia, Critical Care & Pain 2014 ; 14 : 171-5.
 
5) Salles N. Basic mechanisms of the aging gastrointestinal tract. Dig Dis 2007 ; 25 ; 112-7.
PubMed
6) Radtke FM, Franck M, MacGuill M, et al. Duration of fluid fasting and choice of analgesic are modifiable factors for early postoperative delirium. Eur J Anaesthesiol 2010 ; 27 : 411-6.
PubMed
7) Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. The Cochrane database of systematic reviews. 2003 (4) : CD004423.
PubMed
8) Morgeli R. Perioperative Management of Elderly Patients with Gastrointestinal Malignancies : The Contribution of Anesthesia. Visc Med 2017 ; 33 : 267-74.
PubMed

Q15 若年・壮年と比べた高齢者の薬物動態・薬力学の特徴について教えてください。

P.64 掲載の参考文献
1) Masui K, Kira M, Kazama T, et al. Early phase pharmacokinetics but not pharmacodynamics are influenced by propofol infusion rate. Anesthesiology 2009 ; 111 : 805-17.
 
2) Masui K, Upton RN, Doufas AG, et al. The performance of compartmental and physiologically based recirculatory pharmacokinetic models for propofol : a comparison using bolus, continuous, and target-controlled infusion data. Anesth Analg 2010 ; 111 : 368-79.
PubMed
3) Kirkpatrick T, Cockshott ID, Douglas EJ, et al. Pharmacokinetics of propofol (diprivan) in elderly patients. Br J Anaesth 1988 ; 60 : 146-50.
PubMed
4) Minto CF, Schnider TW, Egan TD, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology 1997 ; 86 : 10-23.
PubMed
5) Singleton MA, Rosen JI, Fisher DM. Pharmacokinetics of fentanyl in the elderly. Br J Anaesth 1988 ; 60 : 619-22.
PubMed
6) Varrique RM, Lauretti GR, Matsumoto JA, et al. Pharmacokinetics and pharmacodynamics of rocuronium in young adult and elderly patients undergoing elective surgery. Journal of Pharmacy and Pharmacology 2016 ; 68 : 1351-8.
PubMed
7) Ishigaki S, Masui K, Kazama T. Saline Flush After Rocuronium Bolus Reduces Onset Time and Prolongs Duration of Effect : A Randomized Clinical Trial. Anesth Analg 2016 ; 122 : 706-11.
PubMed
8) Schnider TW, Minto CF, Shafer SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999 ; 90 : 1502-16.
PubMed
9) Katoh T, Bito H, Sato S. Influence of age on hypnotic requirement, bispectral index, and 95% spectral edge frequency associated with sedation induced by sevoflurane. Anesthesiology 2000 ; 92 : 55-61.
PubMed
10) Eger EI 2nd. Age, minimum alveolar anesthetic concentration, and minimum alveolar anesthetic concentration-awake. Anesth Analg 2001 ; 93 : 947-53.
PubMed
11) Scott JC, Stanski DR. Decreased fentanyl and alfentanil dose requirements with age. A simultaneous pharmacokinetic and pharmacodynamic evaluation. J Pharmacol Exp Ther 1987 ; 240 : 159-66.
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12) Bevan DR, Fiset P, Balendran P, et al. Pharmacodynamic behaviour of rocuronium in the elderly. Can J Anaesth 1993 ; 40 : 127-32.
PubMed
13) Vuyk J. Pharmacodynamics in the elderly. Best Pract Res Clin Anaesthesiol 2003 ; 17 : 207-18.
PubMed

Q16 術前にオピオイドを使用している患者の周術期オピオイド管理について教えてください。

P.69 掲載の参考文献
1) 日本ペインクリニック学会非がん性慢性疼痛に対するオピオイド鎮痛薬処方ガイドライン作成ワーキンググループ, 編. 非がん性慢性疼痛に対するオピオイド鎮痛薬処方ガイドライン (改訂第2版). 東京 : 真興交易 ; 2017. p.1-262.
 
2) Doan L, Largi J, Choi L, et al. Acute pain management in the opioid-dependent patient. Hadzic A, ed. Hadzic's Text Book of Regional Anesthesia (2nd ed). New York, U. S. A. : McGraw-Hill Education ; 2017. p.967-76.
 
3) 特定非営利活動法人日本緩和医療学会緩和医療ガイドライン委員会, 編. がん疼痛の薬物療法に関するガイドライン (2020年版). 東京 : 金原出版 ; 2020. p.1-178.
 
4) Mohanty S, Rosenthal RA, Russell MM, et al. Optimal Perioperative Management of the Geriatric Patient : Best Practices Guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 2016 ; 222 : 930-47.
PubMed
5) 廣瀬宗孝. 非がん性慢性疼痛治療におけるモルヒネの役割と注意点-他のオピオイド鎮痛薬も含めて. 日本医事新報. 2019 ; 4956 : 30-4.
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6) Olotu C, Weimann A, Bahrs C, et al. The Perioperative care of older patients. Dtsch Arztebl Int 2019 ; 116 : 63-9.
PubMed
7) Stein C, Kopf A. Management of the patient with chronic pain. Gropper MA, ed. Miller's Anesthesia (9th ed). Philadelphia, U. S. A. : Elsevier ; 2020. p.1604-21.
 

Q17 周術期抗菌薬投与とは ? 高齢者における注意点は ?

P.73 掲載の参考文献
1) 日本化学療法学会/日本外科感染症学会術後感染予防抗菌薬適正使用に関するガイドライン作成委員会編. 術後感染予防抗菌薬適正使用のための実践ガイドライン. 2016年, 2020年版.
 
2) 岩田健太郎. 目からウロコ! 外科医のための感染症の見方, 考え方. 東京 : 中外医学社 ; 2015.
 
3) 感染症の手引き編集委員会編. 感染症診療の手引き. 東京 : 双文社 ; 2011.
 

Q18 高齢者ではどの麻酔薬の選択が望ましいのか教えてください。

P.76 掲載の参考文献
1) Belrose JC, Noppens RR. Anesthesiology and cognitive impairment : a narrative review of current clinical literature. BMC Anesthesiol 2019 ; 19 : 241.
 
2) Conzen P, Peter K. Inhalation anaesthesia at the extremes of age : geriatric anaesthesia. Anaesthesia 1995 ; 50 Suppl : 29-33.
PubMed
3) Shin S, Kim SH, Park KK, et al. Effects of anesthesia techniques on outcomes after hip fracture surgery in elderly patients : a prospective, randomized, controlled trial. J Clin Med 2020 ; 9 : E1605.
PubMed
4) Muramatsu T, Isono S, Ishikawa T, et al. Differences of recovery from rocuronium-induced deep paralysis in response to small doses of sugammadex between elderly and nonelderly patients. anesthesiology 2018 ; 129 : 901-11.
PubMed
5) Li CJ, Wang BJ, Mu DL, et al. Randomized clinical trial of intraoperative dexmedetomidine to prevent delirium in the elderly undergoing major non-cardiac surgery. Br J Surg 2020 ; 107 : e123-132.
PubMed

Q19 高齢者の処置時の鎮静について教えてください。

P.80 掲載の参考文献
1) American Society of Anesthesiologists : Practice guidelines for sedation and analgesia by non-anesthesiologists : An updated report. Anesthesiology 2002 ; 96 : 1004-17.
 
2) Zomorodi K, Donner A, Somma J, et al. Population pharmacokinetics of midazolam administered by target controlled infusion for sedation following coronary artery bypass grafting. Anesthesiology. 1998 ; 89 : 1418-29.
PubMed
3) Shafer SL, Varvel JR, Aziz N, et al. Pharmacokinetics of fentanyl administered by computer-controlled infusion pump. Anesthesiology. 1990 ; 73 : 1091-102.
PubMed
4) Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018. Anesthesiology. 2018 ; 128 : 437-79.
PubMed
5) 日本麻酔科学会. 麻酔薬および麻酔関連薬使用ガイドライン 第3版. https://anesth.or.jp/users/person/guide_line/medicine (2021年4月7日閲覧)
 

Q20 術中に脳波モニターで麻酔深度をモニターすべきですか ?

P.82 掲載の参考文献
1) Miller RD, et al. Anesthesia 8th ed. Philadelphia : Elsevier ; 2015. p.2407-22.
 
2) 日本老年医学会. 薬物有害事象の回避. 高齢者の安全な薬物ガイドライン 2015. 東京 : メジカルビュー社. p.12-6.
 
3) Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017 ; 34 : 192-214.
PubMed
4) Hou R, Wang H, Chen L, et al. POCD in patients receiving total knee replacement under deep vs light anesthesia : A randomized controlled trial. Brain Behav 2018 ; 8 : e00910.
PubMed
5) Valentin LSS, Pereira VFA, Pietrobon RS, et al. Effects of Single Low Dose of Dexamethasone before Noncardiac and Nonneurologic Surgery and General Anesthesia on Postoperative Cognitive Dysfunction-A Phase III Double Blind, Randomized Clinical Trial. PLoS ONE 2016 ; 11 : e0152308.
 
6) Radtke FM, Franck M, Lendner J, et al. Monitoring depth of anaesthesia in a randomized trial decreases the rate of postoperative delirium but not postoperative cognitive dysfunction. Br J Anaesth 2013 ; 110 : i98-105.
 

Q21 高齢者での筋弛緩薬や拮抗薬の使用にあたっての注意点を教えてください。

P.86 掲載の参考文献
1) Yamamoto S. Yamamoto. Y, Kitajima O, et al. Reversal of neuromuscular block with sugammadex : a comparison of the corrugated supercilli and adductor polices muscles in a randomized doseresponse study. Acta Anaesthesiol Scand 2015 : 59 : 892-901.
 
2) Furuya T, Suzuki T, Kashiwai A, et al. The effects of age on maintenance of intense neuromuscular block with rocuronium. Acta Anaesthesiol Scand 2012 : 56 : 236-9.
PubMed
3) Suzuki T. Kitajima O, Ueda K, et al. Reversibility of rocuronium-induced profound neuromuscular block with sugammadex in younger and older patients. Br Anaesth 2011 ; 106 : 823-6.
PubMed
4) Muramatsu T, Isono S, Ishikawa T, et al. Differences of Recovery from Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex between Elderly and Nonelderly Patients. Anesthesiology 2018 : 129 : 901-11.
PubMed

Q22 高齢者での筋弛緩モニタリングに適した部位について教えてください。

P.90 掲載の参考文献
1) 鈴木孝浩. Clear Q&A 75 筋弛緩薬を知りつくす. 第1版. 東京 : 克誠堂出版 ; 2017. p.159-60.
 
2) 北島治. 筋弛緩モニタリングの機器, モニタリングの部位, モニタリングの実際. 日臨麻会誌 2016 ; 36 : 63-71.
 
3) Ki J, Tae A. Updated review of resistance to neuromuscular blocking agents. Anesth Pain Med 2018 ; 13 : 122-7.
 

Q23 若年者と比べた高齢者の循環機能の特徴について教えてください。

P.94 掲載の参考文献
1) Heit JA. Epidemiology of venous thromboembolism. Nat Res Cardiol 2015 ; 12 : 464-74.
 
2) Kawano T, Tanaka K, Chi H, et al. Effects of aging on isoflurane-induced and protein kinase A-mediated activation of ATP-sensitive potassium channels in cultured rat aortic vascular smooth muscle cells. J Cardiovasc Pharmacol 2010 ; 56 : 676-85.
 
3) 清水逸平, 南野徹. 心臓における老化シグナルの意義. 心臓 2017 ; 49 : 1208-12.
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4) Lakatta EG, Levy D. Arterial and cardiac aging : major shareholders in cardiovascular disease enterprises. Part II : the aging heart in health : links to heart disease. Circulation 2003 : 107 ; 139-46.
 
5) Carabello BA, Paulus WJ. Aortic stenosis. Lancet 2009 : 373 ; 956-66.
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6) 日本循環器病学会. 急性・慢性心不全診療ガイドライン (2017年改訂版). https://www.j-circ.or.jp/old/guideline/pdf/JCS2017_tsutsui_h.pdf (2021年3月8日閲覧)
 

Q24 高齢者での術中の輸液管理の注意点について教えてください。

P.98 掲載の参考文献
1) 小竹良文, 篠田重男, 牧裕一, ほか. 高リスク手術における輸液管理. 日臨麻会誌 2015 ; 35 : 41-7.
Medical*Online
2) 多田羅恒雄. 侵襲時輸液のブレイクスルー. 循環制御 2014 ; 35 : 209-18.
Medical*Online
3) 中島芳樹. 血管内グリコカリックスを考慮した輸液戦略. 臨床科学 2020 ; 49 : 30-9.
 
4) Tatara T. Context-sensitive fluid therapy in critical illness. J Intensive Care 2016 ; 4 : 20.
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5) Milford EM, Reade MC. Resuscitation fluid choices to preserve the endothelial glycocalyx. Crit Care 2019 ; 23 : 77.
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6) Zeng Y, Adamson RH, Curry FR, et al. Sphingosine-1-phosphate protects endothelial glycocalyx by inhibiting syndecan-1 shedding. Am J Physiol Heart Circ Physiol 2014 ; 306 : H363-72.
PubMed
7) Torres LN, Chung KK, Salgado CL, et al. Low-volume resuscitation with normal saline is associated with microvascular endothelial dysfunction after hemorrhage in rats, compared to colloids and balanced crystalloids. Crit Care 2017 ; 21 : 160.
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8) Wong YL, Lautenschlager I, Dombrowsky H, et al. Hydroxyethyl starch (HES 130/0.4) impairs intestinal barrier integrity and metabolic function : findings from a mouse model of the isolated perfused small intestine. PLoS One 2015 ; 10 : e0121497.
 
9) Machin DR, Phuong TT, Donato AJ. The role of the endothelial glycocalyx in advanced age and cardiovascular disease. Curr Opin Pharmacol 2019 ; 45 : 66-71.
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10) Cannesson M, Musard H, Desebbe O, et al. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg 2009 ; 108 : 513-7.
PubMed
11) Mair S, Tschirdewahn J, Gotz S, et al. Applicability of stroke volume variation in patients of a general intensive care unit : a longitudinal observational study. J Clin Monit Comput 2017 ; 31 : 1177-87.
PubMed
12) Mathis MR, Duggal NM, Likosky DS, et al. Intraoperative Mechanical Ventilation and Postoperative Pulmonary Complications after Cardiac Surgery. Anesthesiology 2019 ; 131 : 1046-62.
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13) Monnet X, Marik PE, Teboul JL. Prediction of fluid responsiveness : an update. Ann Intensive Care 2016 ; 6 : 111.
PubMed
14) Monnet X, Teboul JL. Assessment of fluid responsiveness : recent advances. Curr Opin Crit Care 2018 ; 24 : 190-5.
PubMed

Q25 高齢者に対する輸血はどのように行い, 何を注意すればいいですか ?

P.101 掲載の参考文献
1) 米村雄士, 松本雅則, 稲田英一, ほか. 科学的根拠に基づいた赤血球製剤の使用ガイドライン. 日輸血細胞治療会誌 2016 ; 62 : 641-50.
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2) Goodnough LT, Maggio P, Hadhazy E, et al. Restrictive blood transfusion practices are associated with improved patient outcomes. Transfusion 2014 ; 54 (10 Pt 2) : 2753-9.
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3) Holst LB, Petersen MW, Haase N, et al. Restrictive versus liberal transfusion strategy for red blood cell transfusion : systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015 ; 350 : h1354.
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4) Carson JL. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. The Cochrane database of systematic reviews 2012 ; 10 : 1-61.
 
5) Nordestgaard AT, Rasmussen LS, Sillesen M, et al. Red blood cell transfusion in surgery : an observational study of the trends in the USA from 2011 to 2016. Anaesthesia 2020 ; 75 : 455-63.
 
6) Tanaka KA, Szlam F. Treatment of massive bleeding with prothrombin complex concentrate : argument for. J Thromb Haemost 2010 ; 8 : 2589-91.
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7) Sorensen B, Bevan D. A critical evaluation of cryoprecipitate for replacement of fibrinogen. Br J Haematol 2010 ; 149 : 834-43.
 
8) Nascimento B, Goodnough LT, Levy JH. Cryoprecipitate therapy. Br J Anaesth 2014 ; 113 : 922-34.
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9) Collins PW, Solomon C, Sutor K, et al. Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate. Br J Anaesth 2014 ; 113 : 585-95.
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10) 田崎哲典, 岡崎仁, 稲田英一, ほか. TRALI, TACO鑑別診断のためのガイドライン. 日輸血細胞治療会誌 2015 ; 61 : 474-9.
Medical*Online

Q26 周術期高齢者の体温調節機能の特徴について教えてください。

P.105 掲載の参考文献
1) Hamel MB, Henderson WG, Khuri SF, et al. Surgical outcomes for patients aged 80 and older : morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 2005 ; 53 : 424-9.
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2) Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery : a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005 ; 24 : 466-77.
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3) Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013 ; 381 : 752-62.
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4) Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia : European consensus on definition and diagnosis : Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010 ; 39 : 412-23.
 
5) Inoue Y, Nakao M, Araki T, et al. Regional differences in the sweating responses of older and younger men. J Appl Physiol 1991 ; 71 : 2453-9.
 
6) Khan F, Spence VA, Belch JJ. Cutaneous vascular responses and thermoregulation in relation to age. Clin Sci 1992 ; 82 : 521-8.
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7) Frank SM, Beattie C, Christopherson R, et al. Epidural Versus General Anesthesia, Ambient Operating Room Temperature, and Patient Age as Predictors of Inadvertent Hypothermia. Anestheiology 1992 ; 77 : 252-7.
 
8) Matsukawa T, Sessler DI, Sessler AM, et al. Heat flow and distribution during induction of general anesthesia. Anesthesiology 1995 ; 82 : 662-73.
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9) Frank SM, El-Rahmany HK, Cattaneo CG, et al. Predictors of hypothermia during spinal anesthesia. Anesthesiology 2000 ; 92 : 1330-4.
PubMed
10) Erdling A, Johansson A. Core temperature--the intraoperative difference between esophageal versus nasopharyngeal temperatures and the impact of prewarming, age, and weight : a randomized clinical trial. AANA J 2015 ; 83 : 99-105.
 

Q27 若年者と比べた高齢者の呼吸機能の特徴について教えてください。

P.107 掲載の参考文献
1) Sprung J, Gajic O, Warner DO. Review article : Age related alterations in respiratory function-anesthetic considerations. Can J Anaesth 2006 ; 53 : 1244-57.
PubMed
2) Roman MA, Rossiter HB, Casaburi R. Exercise, ageing and the lung. Eur Respir J 2016 ; 48 : 1471-86.
PubMed
3) Lalley PM. The adding respiratory system -- pulmonary structure, function and neural control. Respir Physiol Neurobiol 2013 ; 187 : 199-210.
 
4) Alvis BD, Hughes CG. Physiology Considerations in the Geriatric Patient. Anethesiol Clin 2015 ; 33 : 447-56.
PubMed
5) Miles B, Leah A, Stacie D. Geriatric Anesthesia. In : Michel AG, editor. Miller's Anesthesia. Vol 2. 9th ed. Philadelphia : Elsevier ; 2019. p.2105
 
6) 河野太郎, 柏田政利, 恒吉勇男. 3. 加齢による生理機能の変化. 澄川耕二, 編. 高齢者の周術期管理. 東京 : 克誠堂出版 ; 2014. p.15-7.
 

Q28 高齢者の気道確保時の注意点について教えてください。

P.113 掲載の参考文献
1) Johnson KN, Botros DB, Groban L, et al. Anatomic and physiopathologic changes affecting the airway of the elderly patient : implications for geriatric-focused airway management. Clin Invest Aging 2015 ; 10 : 1925-34.
 
2) 原田秀樹, 佐藤公則, 牛島一男. 高齢者の全身管理 : 気道管理. 澄川耕二編, 高齢者の周術期管理. 東京 : 克誠堂出版 ; 2014, p.120-7.
 
3) Japanese Society of Anesthesiologists. JSA airway management guideline 2014 : to improve the safety of induction of anesthesia. J Anesth 2014 ; 28 : 482-93.
PubMed

Q29 高齢者の術後の呼吸器系合併症予防には気管挿管と声門上器具のどちらがいいですか ?

P.116 掲載の参考文献
1) Griffiths R, Beech F, Brown A, et al. Peri-operative care of the elderly 2014 : Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2014 ; 69 Suppl 1 : 81-98.
 
2) Amato MB, Meade MO, Slutsky AS, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015 ; 372 : 747-55.
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3) Asai T, Isono S. Residual neuromuscular blockade after anesthesia : a possible cause of postoperative aspiration-induced pneumonia. Anesthesiology 2014 ; 120 : 260-2.
 
4) Asai T, Morris S. The laryngeal mask airway : Its features, effects and role. Can J Anaesth 1994 ; 41 : 930-60.
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5) 浅井隆. これでわかった! 図説ラリンジアルマスク. 東京 : 克誠堂出版 ; 2009.
 

Q30 高齢者の抜管時の注意点はありますか ?

P.120 掲載の参考文献
1) Tung A, Fergusson NA, Ng N, et al. Medications to reduce emergence coughing after general anaesthesia with tracheal intubation : a systematic review and network meta-analysis. Br J Anaesth 2020 Feb 22 ; S0007-0912 (20) 30012-X.
 
2) Bedet A, Tomberli F, Prat G, et al. Myocardial ischemia during ventilator weaning : a prospective multicenter cohort study. Crit Care 2019 ; 23 : 321.
PubMed
3) McEvoy MD, Gupta R, Koepke EJ, et al. Perioperative Quality Initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth 2019 ; 122 : 575-86.
PubMed
4) Aouad MT, Al-Alami AA, Nasr VG, et al. The effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia. Anesth Analg 2009 ; 108 : 1157-60.
 
5) Muramatsu T, Isono S, Ishikawa T, et al. Differences of Recovery From Rocuronium-induced Deep Paralysis in Response to Small Doses of Sugammadex Between Elderly and Nonelderly Patients. Anesthesiology 2018 ; 129 : 901-11.
PubMed
6) Broens SJ, Boon M, Martini CH, et al. Reversal of Partial Neuromuscular Block and the Ventilatory Response to Hypoxia : A Randomized Controlled Trial in Healthy Volunteers. Anesthesiology 2019 ; 131 : 467-76.
PubMed

Q31 抜管後に指示に従えない場合, 退室基準はどのように判断すればいいですか。

P.123 掲載の参考文献
1) Abelha FJ, Luis C, Veiga D, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care 2013 ; 17 : R257.
PubMed
2) Gopalakrishnan NA, Sakata DJ, Orr JA, et al. Hypercapnia shortens emergence time from inhaled anesthesia in pigs. Anesth Analg 2007 ; 104 : 815-21.
PubMed
3) Vlisides PE, Thompson A, Kunkler BS, et al. Perioperative epidural use and risk of delirium in surgical patients : a secondary analysis of the PODCAST trial. Anesth Analg 2019 ; 128 : 944-52.
PubMed
4) 抗血栓療法中の区域麻酔・神経ブロックガイドライン 第1版 http://www.regional-anesth.jp/antithrombotic/pdf/guideline2.pdf (2020年6月21日閲覧)
 
5) Misal US, Joshi SA, Shaikh MM, et al. Delayed recovery from anesthesia : a postgraduate educational review. Anesth Essays Res 2016 ; 10 : 164-72.
PubMed

Q32 高齢者での術後痛の特徴と疼痛評価法を教えてください。

P.125 掲載の参考文献
1) World Health Organization. (2000). Healthy ageing : adults with intellectual disabilities : summative report. https://apps.who.int/iris/handle/10665/66367 (2021年3月8日閲覧)
 
2) El Tumi H, Johnson MI, Dantas PBF, et al. Age-related changes in pain sensitivity in healthy humans : A systematic review with meta-analysis. Eur J Pain 2017 ; 21 : 955-64.
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3) Farrell M, Gibson S. Age interacts with stimulus frequency in the temporal summation of pain. Pain Medicine 2007 ; 8 : 514-20.
 
4) Omar NM, Hussein AM, Malek HA, et al. Influence of age on pain sensitivity in response to paw pressure and formalin injection in rats : a role of nitric oxide. Gen. Physiol. Biophys 2012 ; 31 : 185-94.
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5) Zhang RX, Lao L, Qiao JT, et al. Effects of aging on hyperalgesia and spinal dynorphin expression in rats with peripheral inflammation. Brain Research 2004 ; 999 : 135-41.
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6) Gagliese L, Weizblit N, Ellis W, et al. The measurement of postoperative pain : a comparison of intensity scales in younger and older surgical patients. Pain 2005 ; 117 : 412-20.
PubMed

Q33 高齢者での術後悪心・嘔吐 ( PONV ) 予防法を教えてください。

P.129 掲載の参考文献
1) Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 2012 ; 109 : 742-53.
PubMed
2) Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg 2020 ; 131 : 411-48.
PubMed
3) Braga ELC, Figueiredo NV, Barrucand L, et al. Use of palonosetron and ondansetron in the prophylaxis of postoperative nausea and vomiting in women 60 years of age or older undergoing laparoscopic cholecystectomy. Eur J Anaesthesiol 2019 ; 36 : 241-2.
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4) Ryu JH, Jeon YT, Min B, et al. Effects of palonosetron for prophylaxis of postoperative nausea and vomiting in high-risk patients undergoing total knee arthroplasty : A prospective, randomized, double-blind, placebo-controlled study. PLoS One 2018 ; 13 : e0196388.
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5) Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004 ; 350 : 2441-51.
 
6) Myles PS, Leslie K, Chan MT, et al. The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II) : a randomised, single-blind trial. Lancet 2014 ; 384 : 1446-54.
 
7) Apfel, CC, A Turan, K Souza, et al. Intravenous acetaminophen reduces postoperative nausea and vomiting : a systematic review and meta-analysis. Pain 2013 ; 154 : 677-89.
 
8) Chan, EY, M Fransen, DA Parker, et al. Femoral nerve blocks for acute postoperative pain after knee replacement surgery. Cochrane Database Syst Rev 2014 : CD009941.
 
9) Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2015 : CD003281.
PubMed
10) McKeage K, Simpson D, Wagstaff AJ. Intravenous droperidol : a review of its use in the management of postoperative nausea and vomiting. Drugs 2006 ; 66 : 2123-47.
PubMed

Q34 高齢者に多い術後合併症について教えてください。

P.133 掲載の参考文献
1) Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg 2006 ; 203 : 865-77.
PubMed
2) Strom C, Rasmussen LS, Steinmetz J. Practical Management of Anaesthesia in the Elderly. Drugs Aging 2016 ; 33 : 765-77.
PubMed
3) Jung J, Moon SM, Jang HC, et al. Incidence and risk factors of postoperative pneumonia following cancer surgery in adult patients with selected solid cancer : results of "Cancer POP"study. Cancer Med 2018 ; 7 : 261-69.
PubMed
4) Yang CK, Teng A, Lee DY, et al. Pulmonary complications after major abdominal surgery : National Surgical Quality Improvement Program analysis. J Surg Res 2015 ; 198 : 441-9.
PubMed
5) Sprung J, Gajic O, Warner DO. Review article : age related alterations in respiratory function-anesthetic considerations. Can J Anaesth 2006 ; 53 : 1244-57.
PubMed
6) Goren O, Matot I. Perioperative acute kidney injury. Br J Anaesth 2015 ; 115 Suppl 2 : ii3-14.
 
7) Zarbock A, Koyner JL, Hoste EAJ, et al. Update on Perioperative Acute Kidney Injury. Anesth Analg 2018 ; 127 : 1236-45.
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8) Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth 2001 ; 87 : 608-24.
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9) Turrentine FE, Sohn MW, Jones RS. Congestive Heart Failure and Noncardiac Operations : Risk of Serious Morbidity, Readmission, Reoperation, and Mortality. J Am Coll Surg 2016 ; 222 : 1220-9.
PubMed
10) Hood R, Budd A, Sorond FA, et al. Peri-operative neurological complications. Anaesthesia 2018 ; 73 Suppl 1 : 67-75.
 

Q35 術後せん妄と術後認知機能障害の違いについて教えてください。

P.136 掲載の参考文献
1) Deiner S, Silverstein JH. Postoperative Delirium and Cognitive Dysfunction. Br J Anaesth 2009 ; 103 : i41-6.
PubMed
2) Drews T, Franck M, Radtke FM, et al. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient : a prospective observational study. Eur J Anaesthesiol 2015 ; 32 : 147-51.
 
3) Avidan MS, Evers AS. The Fallacy of Persistent Postoperative Cognitive Decline. Anesthesiology 2016 ; 124 : 255-8.
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4) Janssen TL, Steyerberg EW, Langenberg JCM, et al. Multimodal prehabilitation to reduce the incidence of delirium and other adverse events in elderly patients undergoing elective major abdominal surgery : An uncontrolled before-and-after study. PLoS One 2019 ; 14 : e0218152.
PubMed
5) Witlox J, Eurelings LS, de Jonghe JF, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia : a meta-analysis. JAMA 2010 ; 304 : 443-51.
PubMed

Q36 術後せん妄の評価法, 発生率, 危険因子を教えてください。

P.141 掲載の参考文献
1) 石田和慶, 松本美志也. 術後せん妄・認知機能障害の評価と危険因子・危険症例の予測. 麻酔 2020 ; 69 : 484-95.
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2) Yoshitani K, Kawaguchi M, Ishida K, et al. Guidelines for the use of cerebral oximetry by near-infrared spectroscopy in cardiovascular anesthesia : a report by the cerebrospinal Division of the Academic Committee of the Japanese Society of Cardiovascular Anesthesiologists (JSCVA). J Anesth 2019 ; 33 : 167-96.
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3) 八田耕太郎. 診断. 日本総合病院精神医学会せん妄指針改定班. せん妄の臨床指針. 東京 : 星和書店 ; 2015. p.1-32.
 
4) Hollinger A, Siegemund M, Goettel N, et al. Postoperative Delirium in Cardiac Surgery : An Unavoidable Menace? J Cardiothorac Vasc Anesth 2015 ; 29 : 1677-87.
 
5) 石田和慶, 山下敦生, 山下理, ほか. 術後せん妄. 臨床麻酔 2015 ; 39 : 1645-54.
Medical*Online
6) Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery : a randomised, double-blind, placebo-controlled trial. Lancet 2016 ; 388 : 1893-902.
PubMed
7) Chan MT, Cheng BC, Lee TM, et al. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol 2013 ; 25 : 33-42.
PubMed
8) Wildes TS, Mickle AM, Ben Abdallah A, et al. Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery : The ENGAGES Randomized Clinical Trial. JAMA 2019 ; 321 : 473-83.
PubMed
9) Fritz BA, Maybrier HR, Avidan MS. Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit. Br J Anaesth 2018 ; 121 : 241-8.
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10) Hesse S, Kreuzer M, Hight D, et al. Association of electroencephalogram trajectories during emergence from anaesthesia with delirium in the postanaesthesia care unit : an early sign of postoperative complications. Br J Anaesth 2019 ; 122 : 622-34.
 

Q37 術後認知機能障害の評価法, 発生率, リスクファクターを教えてください。

P.146 掲載の参考文献
1) 河野崇. 術後せん妄と術後認知機能障害 : Up-to-date．麻酔 2020；69：475-83．
Medical*Online
2) 石田和慶, 松本美志也. 術後せん妄・認知機能障害の評価と危険因子・危険症例の予測. 麻酔 2020 ; 69 : 484-95.
Medical*Online
3) Krenk L, Rasmussen LS. Postoperative delirium and postoperative cognitive dysfunction in the elderly- what are the differences? Minerva Anestesiol 2011 ; 77 : 742-9.
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4) Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the elderly : ISPOCD1 study. Lancet 1998 ; 351 : 857-61.
PubMed
5) Evered L, Silbert B, Knopman DS, et al. Recommendations for the nomenclature of Cognitive change associated with anaesthesia and surgery-2018. Anesthesiology 2018 ; 129 : 872-9.
PubMed
6) 吉谷健司, 大西佳彦. 心臓手術後の高次脳機能障害. 麻酔 2009 ; 58 : 308-14.
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7) Monk TG, Weldon BC, Garvan CW, et al. Predictors of cognitive dysfunction after major noncardiac surgery. Anesthesiology 2008 ; 108 : 18-30.
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8) Silbert BS, Evered LA, Scott DA. Incidence of postoperative cognitive dysfunction after general or spinal anaesthesia for extracorporeal shock wave lithotripsy. Br J Anaesth 2014 ; 113 : 784-91.
 
9) Evered L, Scott DA, Silbert B, et al. Postoperative cognitive dysfunction is independent of type of surgery and anesthetic. Anesth Analg 2011 ; 112 : 1179-85.
PubMed
10) Evered LA, Silbert BS. Postoperative Cognitive Dysfunction and Noncardiac Surgery. Anesth Analg 2018 ; 127 : 496-505.
PubMed

Q38 周術期脳梗塞とその予防法を教えてください。

P.150 掲載の参考文献
1) Selim M. Perioperative stroke. N Engl J Med 2007 ; 356 : 706-13.
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2) Pai SL, Wang RD, Aniskevich S. Perioperative stroke : incidence, etiologic factors, and prevention. Minerva Anestesiol 2017 ; 83 : 1178-89.
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3) Jayaraman DK, Mehla S, Joshi S, et al. Update in the Evaluation and Management of Perioperative Stroke. Curr Treat Options Cardiovasc Med 2019 ; 21 : 76.
PubMed
4) Hornor MA, Duane TM, Ehlers AP, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. J Am Coll Surg 2018 ; 227 : 521-536.e1.
 
5) Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery : a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014 ; 64 : e77-137.
 
6) Fallouh N, Chopra V. Statin withdrawal after major noncardiac surgery : risks, consequences, and preventative strategies. J Hosp Med 2012 ; 7 : 573-9.
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7) Leary MC, Varade P. Perioperative Stroke. Curr Neurol Neurosci Rep 2020 ; 20 : 12.
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8) Bijker JB, Persoon S, Peelen LM, et al. Intraoperative hypotension and perioperative ischemic stroke after general surgery : a nested case-control study. Anesthesiology 2012 ; 116 : 658-64.
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9) Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke : 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke : A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019 ; 50 : e344-e418.
 
10) Grau AJ, Eicke M, Burmeister C, et al. Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery. Cerebrovasc Dis 2017 ; 43 : 242-9.
PubMed

Q39 術後に発生する末梢神経障害について教えてください。

P.154 掲載の参考文献
1) 西山純一. 手術体位による合併症-末梢神経障害を中心に-. 日臨麻会誌 2017 ; 37 : 201-9.
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2) Sawyer RJ, Richmond MN, Hickey JD, et al. Peripheral nerve injuries associated with anaesthesia. Anaesthesia 2000 ; 55 : 980-91.
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3) Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia 2018 ; 73 (Supple. 1) : 51-60.
 
4) 今井富裕. 高齢者における末梢神経障害. 日老医誌 2015 ; 52 : 191-9.
 
5) 草野修輔. 高齢者のリハビリテーション. 理学療法科学 2004 ; 19 : 175-81.
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6) Goodpaster BH, Park SW, Harris TB, et al. The loss of skeletal muscle strength, mass, and quality in older adults : the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2006 ; 61 : 1059-64.
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7) Hughes VA, Roubenoff R, Wood M, et al. Anthropometric assessment of 10-y changes in body composition in the elderly. Am J Clin Nutr 2004 ; 80 : 475-82.
PubMed
8) Martin JT. Positioning aged patients. Anesthesiol Clin North Am 2000 ; 18 : 105-21.
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9) 辻本三郎. 術中体位と神経障害. 岩崎寛, 編. 麻酔科診療プラクティス 14 麻酔偶発症・合併症. 東京 : 文光堂 ; 2004. p.192-9.
 
10) Neal JM, Barrington MJ, Brull R, et al. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine. Reg Anesth Pain Med 2015 ; 40 : 401-3.
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11) 日本ペインクリニック学会治療指針検討委員会, 編. ペインクリニック治療指針 (第6版, 2019年7月20日発行). 東京 : 真興交易 (株) 医書出版部.
 
12) 日本ペインクリニック学会神経障害性疼痛薬物療法ガイドライン改訂版作成ワーキンググループ, 編. 神経障害性疼痛薬物療法ガイドライン (第2版, 2016年6月30日発行). 東京 : 真興交易 (株) 医書出版部.
 

Q40 長期臥床患者の周術期肺塞栓症の予防について教えてください。

P.158 掲載の参考文献
1) 松尾武文. 加齢と血栓. 加齢と血栓症の臨床 高齢者の血栓症の特徴とその治療. 血栓と循環 2000 ; 8 : 253-7.
 
2) 日本循環器学会. 肺血栓塞栓症および深部静脈血栓症の診断, 治療, 予防に関するガイドライン (2017年改訂版). www.j-circ.or.jp/guideline/pdf/JCS2017_ito_h.pdf (2020年5月10日閲覧)
 
3) 黒岩政之. 静脈血栓塞栓症 2016～わが国の最新の情報から～. わが国の周術期肺血栓塞栓症の変遷. 血液フロンティア 2016 ; 26 : 331-7.
 
4) Kuroiwa M, Morimatsu H, Tsuzaki K, et al. Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan : Results of the 2002-2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA-PTE) Study. J Anesth ; 2015. 29 : 433-41.
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5) 抗血栓療法中の区域麻酔・神経ブロックガイドライン. http://www.regional-anesth.jp/antithrombotic/pdf/guideline2.pdf (2020年5月10日閲覧)
 

Q41 高齢者での褥瘡対策について教えてください。

P.163 掲載の参考文献
1) 柳手幸恵. 加齢に伴う皮膚の変化と高齢者のスキンケア ドライスキン, スキン-テア. Expert Nurse 2018 ; 34 : 101-5.
 
2) World Union of Wound Healing Societies. Consensus documrnt. Role of dressings in pressure ulcer prevention. Wounds International, 2016.
 
3) National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers : a clinical practice guideline. Washington, DC ; National Pressure Ulcer Advisory Panel, 2014.
 
4) 吉村美音, 大浦紀彦. 最新の周術期褥瘡対策-新たなずれ対策とMicroclimateへの着眼-. 杏林医会誌 2019 ; 50 : 47-53.
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5) https://www.smith-nephew.com/japan/products/woundmanagement/hydrosite-list/allevynlife/ (2021年3月12日閲覧)
 
6) https://aimg.as-1.co.jp/c/63/1330/87/63133086cat.pdf?v=d... (2021年3月12日閲覧)
 

Q42 周術期の転倒予防の方法を教えてください。

P.166 掲載の参考文献
1) Boereboom C, Doleman B, Lund JN, et al. Systematic review of pre-operative exercise in colorectal cancer patients. Tech Coloproctol. 2016 ; 20 : 81-9.
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2) Singh F, Newton RU, Galvao DA, et al. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol. 2013 ; 22 : 92-104.
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Q43 高齢者のICUにおける鎮静について教えてください。

P.169 掲載の参考文献
1) Devlin JW, Skrobik Y, Gelinas C, et al. Guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018 ; 46 : e825-e873.
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2) Chanques G, Sebbane M, Jaber S, et al. A prospective study of pain at rest : incidence and characteristics of an unrecognized symptom in surgical and trauma versus medical intensive care unit patients. Anesthesiology 2007 ; 107 : 858-60.
 
3) Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation Sedation Scale : validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002 ; 166 : 1338-44.
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4) Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 2017 ; 34 : 192-214.
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5) O'Mahony R, Murthy L, Akunne A, et al. Synopsis of the National Institute for Health and Clinical Excellence guideline for prevention of delirium. Ann Intern Med 2011 ; 154 : 746-51.
 
6) American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc 2015 ; 63 : 142-50.
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7) Yoanna S, Matthew S. D, Nicholas S. H, et al. Low-dose nocturnal dexmedetomidine prevents ICU delirium. A randomized, placebo-controlled trial. Am J Respir Crit Care Med 2018 ; 197 : 1147-56.
 

Q44 高齢者での術後早期のリハビリテーションについて教えてください。

P.173 掲載の参考文献
1) 小池有美, 岩橋誠, 中森幹人, ほか. 胸部食道癌患者に対する術前心肺機能強化トレーニング効果に関する前向き研究. 日消外会誌 2010 ; 43 : 487-94.
 
2) 日本リハビリテーション医学教育推進機構, ほか監, 久保俊一, 田島文博, ほか編. 急性期のリハビリテーション医学・医療テキスト. 京都 : 金芳堂出版 ; 2020. p.52-3, 104-6.
 
3) William D Schweickert, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients : a randomised controlled trial. Lancet 2009 ; 373 : 1874-82.
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4) 日本リハビリテーション医学会, 監. 久保俊一, ほか編. リハビリテーション医学・医療コアテキスト. 東京 : 医学書院 ; 2018. p.39.
 

Q45 Post intensive care syndrome ( PICS ) とその予防法を教えてください。

P.177 掲載の参考文献
1) Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit : report from a stakeholders' conference. Crit Care Med 2012 ; 40 : 502-9.
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2) Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU : a systematic review and meta-analysis. Crit Care Med 2013 ; 41 : 1543-54.
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3) Fang F, Zhang Y, Tang J, et al. Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis : A Systematic Review and Meta-analysis. JAMA Intern Med 2019 ; 179 : 213-23.
 
4) Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010 ; 363 : 1107-16.
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5) Harvey MA, Davidson JE. Postintensive Care Syndrome : Right Care, Right Now... and Later. Crit Care Med 2016 ; 44 : 381-5.
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6) Inouye SK, Bogardus ST, Jr., Charpentier PA, et al. A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 1999 ; 340 : 669-76.
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7) Investigators N-SS, Finfer S, Liu B, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012 ; 367 : 1108-18.
 
8) Yatabe T, Inoue S, Sakaguchi M, et al. The optimal target for acute glycemic control in critically ill patients : a network meta-analysis. Intensive Care Med 2017 ; 43 : 16-28.
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9) Huang M, Parker AM, Bienvenu OJ, et al. Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors : A 1-Year National Multicenter Study. Crit Care Med 2016 ; 44 : 954-65.
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10) McIlroy PA, King RS, Garrouste-Orgeas M, et al. The Effect of ICU Diaries on Psychological Outcomes and Quality of Life of Survivors of Critical Illness and Their Relatives : A Systematic Review and Meta-Analysis. Crit Care Med 2019 ; 47 : 273-9.
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Q46 リビング・ウィルと共有意思決定について教えてください。

P.181 掲載の参考文献
1) 中山和弘. 患者中心の意思決定支援. 日手術医会誌 2019 ; 40 : 91-6.
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3) 日本緩和医療学会. 専門家をめざす人のための緩和医療学. 2019.
 
4) 箕岡真子. 日本臨床倫理学会による「POLST (DNAR指示を含む) 作成指針」作成の経緯と今後の展望. 日臨麻会誌 2016 ; 36 : 308-12.
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6) 厚生労働省. 人生の最終段階にあける医療・ケアの決定プロセスに関するガイドライン 2019 https://www.mhlw.go.jp/file/04-Houdouhappyou-10802000-Iseikyoku-Shidouka/0000197701.pdf (2020年5月30日閲覧)
 

Q47 術前, 心房細動を合併している患者の周術期管理について教えてください。

P.185 掲載の参考文献
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2) Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016 ; 37 : 2893-962.
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3) Dagres N, Chao TF, Fenelon G, et al. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function : what is the best practice? Europace 2018 ; 20 : 1399-421.
 
4) Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke : results from the National Registry of trial Fibrillation. JAMA 2001 ; 285 : 2864-70.
 
5) Douketis JD, Spyropoulos AC, Kaatz S, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med. 2015 ; 373 : 823-33.
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6) 日本ペインクリニック学会, 日本麻酔科学会, 日本区域麻酔学会. 抗血栓療法中の区域麻酔・神経ブロックガイドライン. http://anesth.or.jp/files/pdf/guideline_kouketsusen.pdf (2020.8.14 最終アクセス)
 
7) Kushimoto S, Fukuoka T, Kimura A, et al. Efficacy and safety of a 4-factor prothrombin complex concentrate for rapid vitamin K antagonist reversal in Japanese patients presenting with major bleeding or requiring urgent surgical or invasive procedures : a prospective, open-label, single-arm phase 3b study. Int J Hematol 2017 ; 106 : 777-86.
 

Q48 大腿骨頸部骨折の麻酔管理の注意点について教えてください。

P.188 掲載の参考文献
1) Klestil T, Roder C, Stotter C, et al. Impact of timing of surgery in elderly hip fracture patients : a systematic review and meta-analysis. Sci Rep 2018 ; 8 : 13933.
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2) HIP ATTACK Investigators. Accelerated surgery versus standard care in hip fracture (HIP ATTACK) : an international, randomised, controlled trial. Lancet 2020 ; 395 : 698-708.
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Q49 TAVIの麻酔管理の注意点について教えてください。

P.190 掲載の参考文献
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Q50 入室時に認知症で暴れています。どうしたらいいですか ?

P.194 掲載の参考文献
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