心アミロイドーシスを有する患者の上腹部緊急手術の麻酔管理

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  • Anesthetic Management of a Patient with Severe Cardiac Amyloidosis Emergent Undergoing Upper Abdominal Surgery.

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A 62-year-old male with cardiac amyloidosis underwent an emergent laparotomy. Cardiac failure had been treated with furosemide at does of up to 480mg•d-1. Upon admission, the patient was severely edematous, and echocardiography showed enhancement of myocardial granular sparkling and impaired diastolic function. Before surgery, deslanoside and furosemide were administered intravenously. Anesthesia was induced with thiopental, ketamine and vecuronium, and maintained with oxygen, nitrous oxide, ketamine and fentanyl. The patient was extubated in the operating room and was transferred to the intensive care unit and then to the ward. The patient was saved from congestive heart failure with deslanoside and furosemide. Two months later, however, he suddenly went into cardiac arrest and died. In a patient with cardiac amyloidosis, preoperative assessment of the cardiac function by echocardiography, and preparation for a cardiac emergency were considered to be especially important.

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