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February 05, 2005

エピ考(1)

最近,毎日のようにエピを入れている。エピに関しては自分の中でもいろいろな葛藤,矛盾がある。脊髄損傷などのリスクがあるため自分から進んで入れたいとは思わないが,エピを入れられない患者の開腹手術や開胸手術ではスムーズに覚醒させる自信がない。常勤の麻酔科医がいる施設でもエピを全廃したところもあると聞いているが,術後鎮痛はフェンタIVのPCAあたりか。 フェンタをうまく使用すればエピなど必要ないかもしれないが,私が帰った後,病棟で呼吸抑制が起こるのが怖い。フェンタの遅発性呼吸抑制はモルヒネほどではないにしても,「エピを入れてほしい」という主治医の希望を退けてまでフェンタIVに固執するのも抵抗がある。結局,これからも毎日トーヒ針の先を脊髄近くまで進めなくてはならない。

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