Japanese

Title	心臓手術後の術後せん妄対策
Subtitle	日本臨床麻酔学会第41回大会シンポジウム 開心術における術後認知機能障害について - 予防と対策 -
Authors	青山文*
Authors (kana)
Organization	*高知大学医学部麻酔科学・集中治療医学講座
Journal	日本臨床麻酔学会誌
Volume	42
Number	5
Page	510-518
Year/Month	2022 /
Article	報告
Publisher	日本臨床麻酔学会
Abstract	[要旨] 心臓手術後の術後せん妄発症率は他の手術と比較して高く, 人工心肺の使用および術後ICU管理などの特殊性を有する. 術後せん妄の発症には脳内神経炎症が関連することが示唆されているが, 治療方法はいまだ確立されていない. 麻酔科医としてまず行うべき術後せん妄対策は疼痛コントロールであるが, 術前のせん妄ハイリスク患者の同定と共有, 術中の脳梗塞予防のための塞栓症対策および麻酔深度モニターの検討, 術後の鎮静管理など, 周術期を通した継続的な対策を講じることが重要である. 心臓手術の低侵襲化により, これまで以上に高齢あるいはハイリスクな患者の心臓麻酔が増加し, 術後せん妄対策の重要性はさらに高まると推察される. 術後せん妄は, 麻酔科医が認知および生命予後に関わる重大な術後合併症であり, 麻酔科医を中心とした多職種連携が求められている.
Practice	臨床医学：外科系
Keywords	術後せん妄, 心臓手術, 脳内神経炎症, 多職種連携, Postoperative delirium, Cardiac surgery, Neuroinflammation, Multidisciplinary intervention

English

Title	Strategies for Postoperative Delirium after Cardiac Surgery
Subtitle
Authors	Bun AOYAMA
Authors (kana)
Organization	Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School
Journal	The Journal of Japan Society for Clinical Anesthesia
Volume	42
Number	5
Page	510-518
Year/Month	2022 /
Article	Report
Publisher	The Japan Society for Clinical Anesthesia
Abstract	Cardiac surgery is associated with a higher incidence of postoperative delirium (POD) than other surgeries and presents special features such as the use of the heart-lung machine and postoperative intensive care unit (ICU) management. Neuroinflammation has been suggested to be associated with the development of POD, but treatment methods have not yet been established. Pain control is the first POD prophylactic management that anesthesiologists should implement. However, it is important to take continuous measures throughout the perioperative period including preoperative identification/sharing of data of patients at high risk of delirium, intraoperative embolism control, anesthesia depth monitoring to prevent cerebral infarction, and postoperative sedation/analgesia management. As cardiac surgery becomes less invasive, cardiac anesthesia will be performed more frequently in elderly and high-risk patients, making POD more prevalent. POD is a severe postoperative complication that impacts the cognition and life prognosis of patients and requires multidisciplinary collaboration in which the anesthesiologist plays a key role.
Practice	Clinical surgery
Keywords	Postoperative delirium, Cardiac surgery, Neuroinflammation, Multidisciplinary intervention

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