臨牀消化器内科 Vol.27 No.10(3-2)


特集名 内視鏡検査・治療時の管理は?
題名 大腸内視鏡 (2) 大腸内視鏡検査における前投薬
発刊年月 2012年 09月
著者 堀井 城一朗 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門
著者 浦岡 俊夫 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門
著者 石居 公之 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門
著者 後藤 修 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門
著者 矢作 直久 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門
【 要旨 】 大腸疾患の診断,大腸検診における検査として大腸内視鏡検査の需要は今後ますます増加していくと考えられる.大腸内視鏡検査を行うに際し,被検者の身体的および精神的苦痛を軽減し,安全で確実な診断・治療を行うためには,適切な前投薬を行う必要がある.その手順として,被検者の情報を十分把握し,静脈ルートの確保,救急対応の準備を行い,適切な種類および量の鎮静薬,鎮痛薬,鎮痙薬の投与を行う.検査中は被検者の状態をモニタリングしながら状態の変化に備え,検査後は十分な休息をとってから帰宅とする.前投薬の種類・量については検査施設の規模に応じての調整が必要であり,それぞれの施設に適した体制作りが重要と考える.
Theme Patient Management During Endoscopic Examination and Treatment
Title Premedication for Screening Colonoscopy
Author Joichiro Horii Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Toshio Uraoka Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Hiroyuki Ishii Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Osamu Goto Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Naohisa Yahagi Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
[ Summary ] Colonoscopy is recognized as the most preferred technique for diagnosis and surveillance of colorectal diseases such as adenomatous polyps or cancer. The role of colonoscopy has increased in recent years in accordance with the increased incidence of colorectal lesions. However, patients occasionally experience pain and discomfort during the procedure. The aim of premedication, including sedation and antispasmodic agents, during colonoscopy is to decrease the patientʼs complaints, and to improve endoscopic performance and safety during colonoscopy. It is important to be aware that complication rates associated with endoscopies increase when premedication, especially sedation, is used. Therefore, thorough risk evaluation before procedures, monitoring and maintenance of intravenous lines during the procedure must be carried out. In addition, properly trained staff members and emergency equipment should be readily available. After the procedure, careful observation of patients in recovery areas is also required. The best approach to premedication in colonoscopies is to choose a premedication regimen considering the individual patient and that it be tailored according to clinical risk assessment and the anxiety level of the individual patient. Furthermore, it is important to adjust the regimen commensurate with the number of attending doctors and the number of trained staff members. Adequate recovery room space and emergency equipment availability are also relevant factors.
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