医学史上初の局所麻酔のみでの腎移植を実施
麻酔の脊髄注射による覚醒下手術
医師らは通常の全身麻酔の代わりに、Nicholas氏を覚醒下で麻酔をかけるために、1回の脊髄注射を使用した。Nicholas氏は、「手術中のある時点で、『脊髄麻酔はもうすぐ効いてくるのかな？』と尋ねたことを覚えている。彼らはすでに多くの作業を行っていたが、私はその事にまったく気づいていなかった。本当に、何の感覚もなかった」と振り返っている。
Nicolas氏は5月24日に手術が成功し、その翌日に退院した。通常、腎臓移植患者は2〜3日入院すると医師らは言う。米Northwestern Medicine Comprehensive Transplant Centerの所長で移植外科医のSatish Nadig氏は、「手術室で腎臓を体内に移植する前に、新しい腎臓がどんなものかを患者に見せることができるのは、信じられないような経験だった。もう一つのエキサイティングなことは、患者が24時間以内に自宅に退院できたことで、基本的に外来での手術とすることができたことだ。われわれは、覚醒下腎移植が全身麻酔のリスクを減らすと同時に、患者の入院期間を短縮できることを期待している」と述べている。
Nicholas氏の手術チームは2時間足らずで彼の腎移植を完了した。同氏には全身麻酔を禁止するような健康上のリスクはなく、全身麻酔に対する恐怖心もなかった。彼の年齢およびリスク因子の少なさこそが、彼が医学史上初の覚醒下腎移植手術に参加する理想的な対象者となった理由だ。米Northwestern Medicineは、全身麻酔ができない患者や、全身麻酔を用いなければこの手術のベネフィットを受ける可能性のある患者に、この種の手術を提供することを計画している。
In a Medical First, Kidney Transplant Is Performed With Regional Anesthesia Only
A spinal injection was used to anesthetize the patient while he remained awake
MONDAY, June 24, 2024 (HealthDay News) -- John Nicolas, a Chicago resident, has become the first person to receive a kidney transplant while awake, according to his doctors at Northwestern Medicine in Chicago.
Instead of using the normal general anesthesia, doctors used a single spinal injection to anesthetize Nicolas while allowing him to remain alert.
"At one point during surgery, I recall asking, 'Should I be expecting the spinal anesthesia to kick in?'" Nicolas, 28, recalled in a news release. "They had already been doing a lot of work and I had been completely oblivious to that fact. Truly, no sensation whatsoever."
This new option could make transplantation available to patients whose health makes them a high risk for general anesthesia, doctors say. It also could substantially decrease the length of a transplant patient's hospital stay.
Nicolas walked out of the hospital the day after his successful surgery, which occurred on May 24. Typically, kidney transplant patients spend two to three days in the hospital, doctors said.
"Inside the operating room, it was an incredible experience being able to show a patient what their new kidney looked like before placing it inside the body," Satish Nadig, M.D., a transplant surgeon and director of the Northwestern Medicine Comprehensive Transplant Center, said in a news release. "The other exciting element is that the patient was able to be discharged home in less than 24 hours, basically making this an outpatient procedure. Our hope is that awake kidney transplantation can decrease some of the risks of general anesthesia while also shortening a patient's hospital stay."
Nicolas's surgical team performed his kidney transplant in less than two hours. Nicolas did not have any health risks that would have prohibited general anesthesia, nor did he have any phobia about it. In fact, his age and limited risk factors made him an ideal candidate to participate in a medical first, and Nicolas leapt at the opportunity.
"He is an extremely compliant patient who was in tune with his body and willing to push the envelope," said Vinayak Rohan, M.D., a transplant surgeon at Northwestern Memorial Hospital. "He had the upmost faith in us, and we had the upmost faith in him."
Northwestern Medicine plans to make this sort of surgery available to patients who cannot have general anesthesia or might otherwise benefit from it.