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February 07, 2007

アンビューも持ち帰っておくんだな


ケタミンで遊んでて死亡するバカが多いために,今年からケタミンが麻薬に指定されてしまった。今年はまだケタラールを使用していないが,使うにしても1ボトル全量を使用することはない。必ず残ってしまう。麻薬が残ると返却伝票が必要になる。


-----------------------------------------------引用開始-------------

「麻薬」アンプル30本、国立循環器病センターで盗難
 大阪府吹田市の国立循環器病センターで、3階の麻酔科の金庫に保管していた麻薬系鎮痛薬「フェンタニル」のアンプル(2cc入り)30本がなくなっていたことが2日、わかった。

 強い毒性とモルヒネの約200倍もの鎮痛効果があるとされ、府警吹田署が窃盗容疑で捜査している。

 一方、昨年12月22日、同センター職員が、患者延べ1100人分の個人情報を記録した私用のノートパソコン1台を紛失していたことも判明した。

 同センターによると、麻薬系鎮痛薬は、1月29日午後、金庫内にあったアンプル50箱(1箱10本入り)のうち、3箱がなくなっていることに麻酔科の医師が気付き、同署と近畿厚生局麻薬取締部などに通報した。別の医師が同日朝、金庫を確認した際には異状はなく、こじ開けたような形跡もないという。

 金庫を開けるためにはカギと暗証番号が必要。カギは同じフロアの麻酔科別室で保管しており、暗証番号は麻酔科の医師13人が知っていた。

 フェンタニルは、クエン酸フェンタニルの商品名。麻薬及び向精神薬取締法で麻薬に指定されており、多幸感をもたらし、依存性があり、禁断症状も起きる。2002年のモスクワ劇場占拠事件で、特殊部隊が使用し、人質が巻き添えとなり中毒死者を出した薬物に混じっていたともいわれる。

(2007年2月2日14時42分 読売新聞)

-----------------------------------------------引用終了-------------


誰が持ち出したのかはさておき,何のために持ち出したのかが気になる。

闇ルートで売りさばくにはそれなりのコネクションが必要だ。まさか六本木で自ら売り歩くわけではあるまい。ネットオークションもまずいだろう。

自分で楽しむためならいきなり30本は多すぎる。それとも,1本ずつくすねて遊んでいるうちに味をしめ,たくさん欲しくなったか。いままでにもフェンタニルの数が1本や2本合わないことがあったのかもしれない。その程度なら警察に通報することもなかっただろう。

麻酔科の薬物乱用は昔からよくあり,今回も誰もが麻酔科医を怪しむと思うが,麻酔科なら露骨な窃盗をしなくてもフェンタニルを自宅に持ち帰ることはいくらでも可能だ。薬局としてはアンプルの数が揃っていることが重要であり,未開封のアンプルを持ち帰るのは難しいが,逆にいうと空アンプル数と使用量とが一致していれば何ら問題ない。
1アンプル2mlのフェンタニルをシリンジに引き,1.5mlしか使用しなかった場合,0.5mlが残ったシリンジと空アンプルを薬局に返却し,さらに返却伝票を書かなくてはならない。この返却伝票を書くのが面倒なため,麻酔チャートには患者に使用したことにして,シリンジ内の0.5mlは密かに廃棄することがある。麻酔チャートには実際には投与されていない0.5mlが記入され,チャート上での使用量と空アンプルの数が合っているので問題ない。密かに廃棄できるなら密かに持ち帰ることも可能だ。ただし,薬液はシリンジに入った状態でしか手に入らない。
持続静注や持続硬膜外では一度に10アンプル以上のフェンタニルをシリンジやバルーン型ポンプに注入する。そのときに3アンプル分ほど生理食塩水とすり替えることだってできる。薄め過ぎると鎮痛効果が弱くなって怪しまれるかもしれないが,大抵は「この患者さん,痛がりだね」で片付けられる。

つまりシリンジに入った状態のフェンタニルなら,一度に30本分は無理にしろ,ある程度は簡単に手に入る。

未開封の30アンプルが盗難された場合,考えられるのは
1)誰かがフェンタニルパーティを予定している。
2)麻酔科医がバイト先で自由に使えるフェンタニルを欲しがった。

1)フェンタニルを飲むとどうなるかは知らない。パーティではおそらく静注か皮下注だろう。だとしたらシリンジと注射針もそれなりの数が必要だ。病院でこれらの在庫が急に減ったら怪しい。しかし国立循環器病センターほどの大病院ならシリンジ+注射針30セットぐらいは誤差の範囲か。バカは注射器の使い回しも気にしないだろうから,5セットもあれば充分かもしれない。しかし,こんなパーティをすると死人がでるだろうな。鉛管硬直が起こるとアンビューだけでは無理だ。マスキュラも数本紛失してないか。

2)の気持ちはよくわかる。バイト先の手術が長引くと用意されたフェンタニルでは足らなくなることがある。追加を薬局から取り寄せたいが,誰かが麻薬伝票を書かなくてはならない。自分で書くのは面倒だし,主治医はじめ外科医は全員が清潔で手を下ろしてまで書いてもらうのは気が引ける。しかも残ったなら返却伝票も必要になる。こんなとき,こっそり使えるフェンタニルがあれば便利だ。

んー。国立循環器病センターの麻酔科医がバイトを禁じられていないとしたら,フェンタニルを盗んだ犯人は,バイト先でフェンタニルを使用している麻酔科医,あるいはヤ○ザの彼がいる***か?


そうそう,私は麻薬どころかいかなる麻酔薬も持ち帰ったことがないことを一言添えておく。もちろん麻酔薬を自分に使用したこともない。

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Comments

>麻酔チャートには患者に使用したことにして,シリンジ内の0.5mlは密かに廃棄することがある。

不特定多数がみるところで、この言葉はまずくないですか?
アルチバは常に残薬が出そうで困っております。

Posted by: 麻酔科医 | February 07, 2007 at 05:32 PM

麻酔科医さん,こんにちは。

まあ,誰もがいつもそうしているわけではなく,そういう手口もあるということでご勘弁ください。

アルチバは術後鎮痛には使えないため,シリンジ内残液の病棟持ち帰りもできませんね。

Posted by: 管理人 | February 07, 2007 at 07:01 PM

麻酔科医先生(HN似ていますね)のおっしゃるようにまずいと思います。
他の薬とわけがちがって麻薬です。取締法違反になりませんか?
ましてや先生はそうしたことがあると記述されています。
警察がブログのホストに依頼すれば先生の身元は割れてしまいます。
即座に対応した方がいいと僭越ながらアドバイス差し上げます。

先生の麻酔関連以外の書き込みは大変的を得ていて面白いと思いますが
麻酔をネタにするのは誤解を招いたりいろいろ問題が出てきます。
ぜひとも慎重にお願いします。

Posted by: ある麻酔科医 | February 08, 2007 at 12:05 PM

「実際に自分がそうしていた」とは書いていないつもりなのですが…。

私は0.5ml残った程度なら使い切ります。抜管が少し遅れますが。三方活栓につなぐときに少しこぼれてしまうこともよくあります。

Posted by: 管理人 | February 08, 2007 at 12:41 PM

よく読むと私の読み違いでした。すみません。
でもやはりこういう話題には慎重になるべきだと思います。
全国の麻酔科医の多くがそうしていると思われてもいけませんし。

先生の今まで書かれたこと、麻酔科医であればある程度理解できますし
共感する部分も多いですが、不特定多数、特に一般の方が見る場合は
大きな誤解をされる可能性があります。どうか慎重にお願いいたします。

Posted by: ある麻酔科医 | February 08, 2007 at 01:46 PM

私はフェンタニルは5mlのアンプルを使用していません。2mlのアンプルを開封しても残液はせいぜい0.5~1.0mlで,残液の処分に面倒を感じたことはあまりありません。先のコメントのように「やや多いかな」と思いながらも使い切ってしまいますが,ときとして痛がりながら覚められ「多いどころか足りてない!」と反省することもあります。アンプルが余れば,もちろん返却伝票を書きます。

ご指摘の点,以後気をつけます。

Posted by: 管理人 | February 08, 2007 at 04:02 PM

つかまったみたいですね!!!
麻薬アンプル30本盗難、国立病院の医師を逮捕
2月15日 読売新聞
http://headlines.yahoo.co.jp/hl?a=20070215-00000012-yom-soci

もうかなりお疲れだったんでしょう。
自分たちしか出せないような金庫から盗むんだから、
相当、本当に相当、判断力が鈍っていたんだとおもいます。

Posted by: 産科医 | February 16, 2007 at 09:23 AM

産科医さん,こんにちは。

困ったことです。麻薬の取り扱いが一段と厳しくなってますます使いにくくなりそうです。

管理の厳しくない薬(プロポフォールやドルミカム)を乱用して,これらの扱いが厳しくなるよりはましかもしれませんが。

Posted by: 管理人 | February 17, 2007 at 12:45 PM

亀コメントで申し訳ないのですが、このエントリーには「慎重に」というコメントが多くつきましたが、敢えて書かれた先生に敬意を表します。このようにゴマカシがまかり通る状況はやはり問題だと思います。国循の医師も初めはそうしていたに違いありません。そして誰も気づかず時すでに遅し、犯罪を犯すほどの身体的依存に陥ってしまったのではないかと。麻酔科学会はただ会員の犯罪に遺憾を表明するだけでいいのでしょうか。起き得るべくして起きた事件のような気もします。具体的な対策はないのでしょうか。手術室薬剤師などが増えて複数で管理できるようになればとか、そのぐらいしか思い浮かびません。私の身の回りでも同じようなことが起きるのではないかと危惧しています。

Posted by: あえて匿名の麻酔科医 | April 04, 2007 at 10:44 PM

あえて匿名の麻酔科医さん,こんにちは。

確かに麻薬のアンプルの管理がどんなに厳しくなっても,麻薬が無色透明の液体であれば,シリンジに充填した状態では簡単に生理食塩水とすり替えられますね。

そこで,フェンタニルを着色すればどうでしょう。シリンジに残っているのがフェンタニルであることが色でわかります。

それでも,不正を働こうとする人間を阻止することは難しいでしょう。

例えば
絵の具が何かを使って同じような色の液体を作り,それをシリンジ内に充たしたものを用意し,ポケットに忍ばせる。
オペ室で同じ容量のフェンタニルをシリンジに引く。
スキをみて両者をすり替える。
絵の具水をフェンタニル残液として薬局に返却。

返却予定のシリンジを上級医が取り上げ「フェンタニルが効いてないじゃないか! 追加するぞ」と患者に静注したら…。小学校の図画のときの,筆を洗ったバケツのあの水と同じ液体が静脈内を流れることに。

シリンジ内残液として返却されたものが本当にその麻薬であるのかどうか薬局が毎回調べているのなら,この絵の具作戦は無理ですね。

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