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<meta name="description" content="麻酔科を目指す医学生，および研修医から麻酔科専門医を対象に，麻酔科にまつわる疑問とその答えを解説したガイドブック．医学生から知っておきたい麻酔の基礎知識から，レジデントが麻酔科研修時にしばしばぶつかる疑問，専門医が臨床の場で判断に悩む問題について，一問一答のＱ&amp;Ａ形式でやさしく明快に解説している．現場での通り一遍な対処法をまとめたマニュアルではなく，麻酔というものへの深い理解が得られる書籍である．">

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		<h1 class="catchCopy">麻酔科研修・臨床の場での「今さら聞けない」疑問に答えます！</h1>
		

		<h1 class="copy">今さら聞けない</h1>
		<h1 class="title">麻酔科の疑問108<span class="version"></span></h1>
		<h2 class="subTitle">基本事項から専門医が知っておきたい知識・テクニックまで</h2>

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					監修：山蔭道明（札幌医科大学麻酔科学講座教授）
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					<span class="transparent">編集</span>　平田直之（札幌医科大学麻酔科学講座講師）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">麻酔科を目指す医学生，および研修医から麻酔科専門医を対象に，麻酔科にまつわる疑問とその答えを解説したガイドブック．医学生から知っておきたい麻酔の基礎知識から，レジデントが麻酔科研修時にしばしばぶつかる疑問，専門医が臨床の場で判断に悩む問題について，一問一答のＱ&Ａ形式でやさしく明快に解説している．現場での通り一遍な対処法をまとめたマニュアルではなく，麻酔というものへの深い理解が得られる書籍である．</section><section class="preface">序文<br><br>　麻酔科医は，よく『縁の下の力持ち』といわれます．例えば，外科手術においては，麻酔科医が麻酔管理および呼吸循環を含めた全身管理を行うことで，患者さんが安心・安全な手術を受けられるよう対応します．集中治療領域では，手術時のみでなく呼吸循環動態が不安定な患者さんの手術後あるいは病棟で急変した際に対応します．ペインクリニック領域では，何らかの痛みを持つ患者さんに必要に応じて神経ブロックや薬剤処方をしているように，いろいろな領域にわたってまさに心技体をもって取り組んでいます．<br>　それでは，医師を目指す高校生あるいは医学部生にとって，麻酔科医あるいは麻酔科学はどう映っているのでしょうか？ 私も医師を目指して大学に入学したわけですが，入学した当初は漠然と外科医を目指しており，麻酔科医など存在すら意識していませんでした．麻酔科医を志し，父にその気持ちを伝えた際も，「それは医師がやる仕事なのか？」とさえいわれたほどです．最近でこそメディアでその重要性や必要性が伝えられるようになり，そのようなことはないと思いますが，第1章では，麻酔科に興味を持っているあるいは『麻酔科学』というものを知りたい現役の医学生向けに，麻酔科学をメインテーマとしてQ＆Aを説明しました．<br>　続いて，2004年に始まった初期臨床研修制度も10年以上が経過し，研修内容も各施設で特色を出しています．研修制度が始まった数年は麻酔科研修が必須でありました．しかし，2017年の現状においては，麻酔科研修は選択制を採用している病院が多いと思います．それによって，麻酔科自体を研修する機会が少なくなり，麻酔科に関するインフォメーションが伝えにくい状況となっています．そこで，第2章においては，初期研修医向けに麻酔科の魅力や麻酔科研修の重要性ほか，研修医が麻酔科を研修するうえでよく悩むと思われる知識など麻酔科の紹介をメインテーマにQ＆Aで説明しました．<br>　そして，ようやく2018年度から専門医機構が主導する専門医制度が始まり，また翌2019年度から新たな更新制度が順次導入されることになりました．それに伴って麻酔科専門医の条件も現状より厳しくなることが予想されています．そこで，第3章では，麻酔科専門医を目指す麻酔専攻医向けに，臨床上判断に苦慮する多くの問題を取り上げ，専門医にふさわしい麻酔科医へと進むことをメインテーマにQ＆A方式に説明しました．<br>　さて，Q＆A方式の質問項目を，90を目標に挙げ進むうちに，どうしても「コラム」として説明を加えたほうがいい項目が18となり，合わせて108となりました．108とはご存じの通り仏教でいうところの煩悩の数です．煩悩とは身心を乱し悩ませ智慧を妨げる心の働き（汚れ）のことをいい，それだけ私たちは多くの心の乱れと戦って生きているわけです．この著書のほとんどは麻酔科学の技術や知識に重きを置いていますが，麻酔科医とは何か？ という大きなテーマにも挑戦したつもりです．執筆者は，監修者の講座に所属する医師が多くなっている一方，実は研修病院として評判のいい施設の先生を選ばせていただいたつもりです．ぜひ，関連するコラムを含めて隅々まで読んでいただき，共感して医学部を目指すひと，麻酔科研修を希望するひと，そして麻酔科専門医を目指して麻酔科専攻医となるひとが一人でも増えたのであれば，本企画をした者として望外の喜びです．<br><br>平成29年1月1日<br>北海道内関連病院出向中にて<br><br>山蔭　道明<br>札幌医科大学医学部麻酔科学講座　教授</section><section class="indexes">I章　基礎編：麻酔科学ってどんなもの？ 誰もが知っておくべき基礎知識Q&amp;A<br>Question 1 麻酔科学ってどんな学問ですか？<br>Question 2 麻酔薬ってどう効くのですか？<br>Question 3 麻酔はなぜ怖いと思われるのでしょうか？<br>Question 4 麻酔薬は，どういった根拠で使い分けする？<br>Question 5 手術の違いと麻酔法の選択について麻酔科医はどう考えているのですか？<br>Question 6 麻酔に必要なものは何ですか？ 麻酔器がなくても麻酔は可能ですか？<br>Question 7 手術室，集中治療室および病棟で患者を鎮静するために使用する薬剤は何をどのような根拠で選ぶのですか？<br>Question 8 脊髄くも膜下麻酔の穿刺を上手に行う麻酔科医は，盲目的であるにもかかわらず，何を指標にしながら針を進めていますか？<br>Question 9 手術終了後，患者の覚醒に向けて麻酔科医は何を考えどのように行動していますか？<br>Question 10 麻酔による起こりやすい合併症は？ さらに起こらないようにどんなことに注意する？<br>II章　実践編：初期研修ではここまで押さえておこうQ&amp;A 27<br>Question 11 笑気ガスをほとんど使用しなくなったのはなぜですか？また，笑気の利点は？<br>Question 12 気管挿管が上達するコツは？<br>Question 13 術中輸液のスタンダードを教えてください<br>Question 14 麻酔導入・維持における筋弛緩薬の上手な使用法は？<br>Question 15 麻酔からの覚醒をスムーズに行うコツは？<br>Question 16 硬膜外麻酔における薬剤の濃度と追加のタイミングは？<br>Question 17 硬膜外麻酔時の血圧低下時は，輸液or血管収縮薬？<br>Question 18 術後硬膜外鎮痛に麻薬は必要？<br>Question 19 子どもの点滴を上手にとるコツは？<br>Question 20 小児はどのくらいの時期からラリンジアルマスクによる管理が可能ですか？<br>Question 21 小児人工呼吸時の適切な呼吸回数は？<br>Question 22 血液ガス分析で酸素化の良し悪しはどう判断するのですか？<br>Question 23 内頚静脈以外の中心静脈ラインの選択は？<br>III章　応用編：ここまでわかれば専門医レベルのQ&amp;A<br>Question 24 術前検査は，どこまで必要ですか？<br>Question 25 術前診察時のリスク評価は，どうしているのですか？<br>Question 26 糖尿病患者は，どの指標がどこまでコントロールされていれば麻酔が可能でしょうか？<br>Question 27 子どもの発熱時に麻酔は可能ですか？<br>Question 28 低流量麻酔はどこまで許容できますか？<br>Question 29 デスフルランは何％で管理しますか？<br>Question 30 セボフルランとデスフルランの使い分けを知りたいです<br>Question 31 MAC-awakeと実際の覚醒時の吸入麻酔薬濃度が違うのはどういうことでしょうか？<br>Question 32 術中に投与するフェンタニルの適正量は，どのように判断したらよい<br>　　　　　　　　でしょうか？<br>Question 33 脱分極性筋弛緩薬はいつ，どんなときに使うのですか？<br>Question 34 腎不全時の筋弛緩拮抗はどうしたらよい？<br>Question 35 手術中の膠質液と晶質液の使い分けは，どんな指標を使って判断したらよい？<br>Question 36 人工呼吸管理している場合の鎮静薬は何がよい？<br>Question 37 現在における肺動脈カテーテルの適応は？<br>Question 38 デクスメデトミジン（プレセデックス<sup>®</sup>）の上手な使い方は？<br>Question 39 尿量計測は，循環管理のモニタリングとして重要ですか？<br>Question 40 INVOSとNIROの評価法は違うの？<br>Question 41 血小板数，凝固機能悪化時のCVC穿刺はどうする？<br>Question 42 フェンタニルでのIV-PCA時，呼吸抑制をどうやってモニタリングする？<br>Question 43 脳外科手術の際の全静脈麻酔（total intravenous anesthesia：TIVA）はどうやってモニタリングして行うのですか？<br>Question 44 適正な鎮静度は何を指標に判断するのですか？<br>Question 45 外傷時の輸血はどうしたらよい？<br>Question 46 回収血輸血は出血を助長するの？<br>Question 47 新鮮凍結血漿製剤の投与についての適切な指標は？<br>Question 48 ラリンジアルマスクの適切なリーク圧はいくつ？<br>Question 49 頭頚部後屈制限のある患者の麻酔導入はどうする？<br>Question 50 声門上器具はさまざまな種類があります．どう使い分けるのですか？<br>Question 51 覚醒下挿管をスムーズにする方法は？<br>Question 52 気管支ブロッカーとダブルルーメンチューブをどう使い分ける？<br>Question 53 一側肺換気中のSpO2低下はどこまで許容できる？<br>Question 54 一側肺換気の際の換気量はどうしたらよい？<br>Question 55 小児の前投薬の是非について教えて下さい<br>Question 56 小児のMRI時にどう鎮静する？<br>Question 57 小児の気道異物，麻酔はどのように行うのがよい？<br>Question 58 小児の挿管チューブはカフなしあるいはカフあり？<br>Question 59 小児硬膜外麻酔のコツは？<br>Question 60 小児挿管困難患者に扁桃摘出術を施行しました．術後の抜管方法は？<br>Question 61 小児をラリンジアルマスクで管理した際，どのように覚醒させるのでしょうか？<br>Question 62 新生児手術時の体温管理はどうしたらよい？<br>Question 63 先天性心疾患術後の肺高血圧症にNO吸入を行うとき，どのくらいの量でいつまで必要？<br>Question 64 高度肥満の妊婦の帝王切開術の麻酔方法は？<br>Question 65 帝王切開時の適切な子宮収縮薬と適切な投与方法は？<br>Question 66 超緊急帝王切開時の全身麻酔はどういう方法で行う？<br>Question 67 severe aortic stenosis（AS）患者の麻酔導入法は？<br>Question 68 心臓手術時，手術が始まるまでにTEEで何を評価したらよい？<br>Question 69 心臓血管麻酔時においてβ刺激薬はどう使う？<br>Question 70 ニトログリセリンとニコランジルの適切な使用法は？ そしてどのように使い分ける？<br>Question 71 OPCABの脱転時の血圧低下にはどうする？<br>Question 72 高度頚動脈狭窄がある狭心症患者のOPCABが予定されました．どう対応する？<br>Question 73 腕頭動脈の解離の有無を確認したい．どうしたらよい？<br>Question 74 COPDで低肺機能患者のステントグラフト手術はどういった麻酔管理がよいですか？<br>Question 75 人工心肺時，αスタットあるいはpHスタットどちらで管理すべき？<br>Question 76 麻酔中の発作性心房細動に対してどう対応する？<br>Question 77 さまざまな非侵襲的心拍測定装置は，どんな症例に必要ですか？<br>Question 78 抗血小板薬あるいは抗凝固薬内服時の神経ブロックはどうする？<br>Question 79 TKA手術時に坐骨神経ブロックはどうしたらよい？<br>Question 80 末梢神経ブロックのカテーテル留置（チュービング）はいつまでするのでしょうか？<br>Question 81 ステロイド投与中の患者の神経ブロックはどうしたらよい？<br>Question 82 上肢と下肢ブロック施行は，全身麻酔前あるいは後にする？<br>Question 83 末梢神経ブロック時の針は，どんなものがあり，どう使い分けるのですか？<br>Question 84 ケタミンが必要な場面は？<br>Question 85 オピオイド治療中の開腹術の麻酔はどうする？<br>Question 86 顔面帯状疱疹になぜSGBが効くの？<br>Question 87 痛みの評価はどうしたらよい？<br>Question 88 オピオイドスイッチングって？<br>Question 89 TRALIの原因・対策は？<br>Question 90 術後感染を防ぐにはどうしたらよい？<br>索引<br><br>COLUMN<br>麻酔科医の仕事にはどういったものがありますか？<br>ケタミン（ケタラール<sup>®</sup> ）ってどんな薬ですか？<br>レミフェンタニル（アルチバ<sup>®</sup> ）ってどんな薬ですか？<br>筋弛緩拮抗薬とはどのようなものですか？<br>麻酔科医の魅力は？<br>Bezold-Jarisch（BJR）反射とは？<br>専門医制度が変わるのですか？<br>麻酔科専門医研修プログラムとは？<br>女性支援事業として麻酔科ができることは？<br>麻酔科医以外の医師は，なぜ，子どもに麻酔科医をすすめるのですか？<br>麻酔科を研修する利点は？<br>麻酔科医のサブスペシャリティーは？<br>開心術からカテーテル治療への変遷は？<br>DOACって何ですか？<br>橈骨動脈も可視化できるのですか？<br>超高齢化社会でも麻酔科医は活躍できる？<br>周術期管理チームへの麻酔科医の関わりとは？<br>Nitric oxide（NO）の適応拡大は？</section></article>
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