台灣麻醉醫學會

 

Case description and literature review

                   09:00-09:50 主講者：陳冠宇醫師／盧奕丞主任／林佳衡主治醫師

 

Peripartum cardiomyopathy (PPCM) is a rare condition that affects women in late pregnancy and in the post-partum period. It is characterized by heart failure that presents in the absence of any other identifiable cause. It is associated with significant morbidity and mortality. Early recognition and aggressive management of the condition is crucial to improving outcome. Over the last few decades, the disease has been extensively researched and investigated for the formulation of diagnostic guidelines and therapeutic approaches. Many theories regarding its pathophysiology have also been proposed. The clinical presentation and the basic and intensive interventional strategies of the disease are more or less similar to that of dilated cardiomyopathy. Apart from intensive care management, these patients may also require anaesthetic intervention for management of painless labor and/or either vaginal or operative delivery. Favorable maternal and fetal outcome require that the basic hemodynamic goals be always kept in mind while choosing the techniques and drugs to provide anesthesia to the patients with PPCM. We present a case of a 32-year-old female pregnant with twins, gravida 2, para 1, at 35 weeks and 4 days of gestation with a previous history of peripartum cardiomyopathy and who was transferred to our hospital for emergent cesarean section due to severe orthopnea and desaturation. Sudden cardiac arrest was noted after induction, and ACLS was performed with successful resuscitation of the patient and her two neonates. 

 

成癮麻醉藥品處方建議

10:10-11:00 主講者：程廣義部長／台灣疼痛醫學會理事長

 

在2016年，台灣疼痛醫學會呼籲，針對65歲以上老人及非癌症之末期病人，應適度放寬管制藥物的使用限制。台灣人民的嗎啡類藥物消耗量以每百萬人口每日界定劑量由362 to 560 (限定每日使用量/每百萬人)消耗量增加55%，在181國家中排名為56名。目前，台灣食藥署已引進新穎嗎啡類藥物，希望能讓嗎啡類藥物能適時適當地被使用。雖然政府基本上鼓勵癌性疾病民眾與非癌性慢性疾病的民眾接受嗎啡類藥物治療，減輕疾病發展的中重度疼痛，但在治療非癌性慢性疼痛病人上，使用嗎啡類藥物的適切性卻值得進一步討論。其實，我國成癮性麻醉藥品均為處方藥及健保給付項目，國人只需經由醫師看診處方，確認實際需要，就能取得成癮性麻醉藥品。我們將在課程中提出目前國際使用成癮性麻醉藥品的使用趨勢及處方建議。