臨牀消化器内科 Vol.32 No.6(1-2)


特集名 高齢者・超高齢者消化管癌の内視鏡治療
題名 総論(2)内視鏡治療時の鎮静・鎮痛薬使用にあたっての留意点
発刊年月 2017年 06月
著者 西澤 俊宏 慶應義塾大学病院腫瘍センター低侵襲治療開発部門/慶應義塾大学医学部消化器内科
著者 木口 賀之 慶應義塾大学病院腫瘍センター低侵襲治療開発部門
著者 光永 豊 慶應義塾大学病院腫瘍センター低侵襲治療開発部門
著者 飽本 哲兵 慶應義塾大学病院腫瘍センター低侵襲治療開発部門
著者 矢作 直久 慶應義塾大学病院腫瘍センター低侵襲治療開発部門
【 要旨 】 内視鏡治療では,時間を要して苦痛を伴うことが多く,患者満足度や治療完遂率向上のためにも鎮静は必要となる.高齢者では呼吸循環器系の機能が低下しており,鎮静薬によるリスクが増加している.治療前に患者の基礎疾患を含め全身状態を十分に把握しておく必要がある.鎮静下の内視鏡治療は,適切な人員配置のもとに,モニター監視下で慎重に行われるべきである.また急変時に迅速な対応ができるように常に準備しておく必要がある.高齢者では鎮静薬を減量投与し,モニタリングだけでなく患者の状態を直接確認しながら追加投与を慎重に検討していく.術後も再鎮静を生じる可能性があり,継続的な観察が必要である.
Theme Endoscopic Treatment for Elderly Patients with Gastro‒intestinal Cancer
Title Sedation and Monitoring for Endoscopic Treatment
Author Toshihiro Nishizawa Division for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine / Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine
Author Yoshiyuki Kiguchi Division for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Yutaka Mitsunaga Division for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Teppei Akimoto Division for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
Author Naohisa Yahagi Division for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine
[ Summary ] Endoscopic treatment is uncomfortable and time‒consuming, thus, sedation is necessary to improve patient satisfaction and success rate of the procedure. Elderly patients having cardiopulmonary dysfunction are at, increased risk associated with administration of sedatives. Adequate pre‒evaluation is important in all, but critical for such patients. When sedation is administered for endoscopic treatment, it is important to appoint experienced staff and ensure a secure environment that allows strict monitoring of patients. Staff members require good training to handle sedation‒related adverse events. Elderly patients should receive reduced doses of sedative agents, and additional doses should be carefully considered based on monitoring and direct observation of the patient's condition. It is essential to continue monitoring the patient following the procedure due to the potential risk of recurrent events from sedative agent effects.
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