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サラブレッド馬における静脈麻酔薬アルファキサロンの臨床薬物特性に関する研究

和久野, 愛 岐阜大学

2020.03.13

概要

神経ステロイド系麻酔薬であるアルファキサロン（Alf）は，日本国内では 2014 年から犬・猫を対象として市販が開始された静脈麻酔薬である。麻酔導入や覚醒が円滑であることや，循環抑制が軽度であることが報告されており，小動物領域では広く普及しつつあるが，馬，特にサラブレッド種における使用報告は少なく，Alf を用いた麻酔法は未だ確立されていない。馬は他の動物種に比べて麻酔関連事故の発生率が高いことから，臨床応用にはより慎重な検討が必要である。そこで本研究では，サラブレッド種における Alf の臨床特性を明らかにするとともに，Alf を用いた麻酔法を検討した。

第 1 章では，サラブレッド種 6 頭を無作為に各 3 回供試し，メデトミジン（Med）（6.0 μg/kg）およびミダゾラム（Mid）（20 μg/kg）による鎮静後，Alf（1.0 mg/kg），ケタミン（Ket）（2.5 mg/kg）およびチオペンタール（Thi）（4.0 mg/kg）のいずれかを投与し，同一条件下で導入・覚醒の臨床特性ならびに呼吸循環系に及ぼす影響を比較検討した。導入・覚醒のスコアは，3 薬物ともグレード 3.5 以上であり，薬物間で有意差は認められなかった。導入時間は，Ket（67 秒）が Alf（49 秒）および Thi（48 秒）と比較して有意に長かった。起立時間は，Alf（44 分）および Thi（39 分）が Ket（25 分）に比較して有意に長かった。いずれの薬物でも，麻酔中の循環動態は臨床的に許容できる範囲内で維持された。一方，呼吸数は有意に低値を示したものの，自発呼吸は消失せず，動脈血二酸化炭素分圧は 50 mmHg 前後で維持された。以上のことから，Alf は，Ket および Thi と同様に，麻酔導入薬として有用であると考えられた。

第 2 章では，サラブレッド種 7 頭を無作為に各 2 回実験に供試し，Med（6.0 μg/kg）および Mid（20 μg/kg）による鎮静後，通常量の Alf（1.0 mg/kg）または通常の 2 倍量の Alf（2.0 mg/kg）を投与し，薬物動態学的および薬力学的特性を評価した。導入・覚醒のスコアは，2 用量ともグレード 4 以上であったが，起立時間は 1.0 mg/kg（50 分）に比較して，2.0 mg/kg（90 分）は有意に延長した。高用量の 2.0 mg/kg でも循環動態は安定して維持されたが，呼吸数は有意に低値を示し，低酸素血症に陥った。消失相半減期，総クリアランスおよび定常状態分布容積の値は，1.0 mg/kg では，58.2 分，11.6 ml/min/kg，0.8 l/kg，2.0 mg/kg では，59.8 分，14.7 ml/min/kg，0.9 l/kg であった。以上のことから，Alf は速やかに血漿中から消失することが明らかとなり，CRI（持続静脈内投与）に適した薬理学特性を有すると考えられた。ただし，呼吸抑制には留意すべきであると考えられた。

第 3 章では，サラブレッド種競走馬の長時間に及ぶ内固定術において，Med（6.0 μg/kg），ブトルファノール（25 μg/kg）およびミダゾラム（20 μg/kg）による鎮静後，Alf（1.0 mg/kg）および 5%グアイフェネシン（500 ml）により導入し，セボフルラン（Sevo）吸入麻酔に Alf（1.0 mg/kg/hr）および Med（3.0 μg/kg/hr）CRI を併用した部分的静脈麻酔により麻酔維持した 1 症例を報告した。手術時間は 180 分，麻酔時間は 230 分であった。術中の平均終末呼気 Sevo 濃度は 1.8％であり，麻酔中の平均動脈圧は 70 mmHg 以上に維持された。吸入麻酔終了から起立までに要した時間は 65 分であった。以上のことから，本麻酔法は，長時間（約 3 時間）の整形外科手術における部分的静脈麻酔として有用である可能性が示唆された。

以上のことから，Alf を用いた麻酔法は，サラブレッド種において，安全かつ有用性の高い方法であることが明らかとなった。

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