[Anesthetic management for laparoscopic cholecystectomy in a patient with dilated cardiomyopathy].
A 55-year-old female with dilated cardiomyopathy was scheduled for laparoscopic cholecystectomy under general anesthesia. Pre-operative tests revealed abnormal ECG and hypokinesis of left ventricular wall motion on echocardiography. A detailed medical examination resulted in the diagnosis of dilated cardiomyopathy, although there was a very mild decrease in cardiac function. We determined that laparoscopic cholecystectomy could be safely carried out under general anesthesia if pneumoperitoneum pressure was kept low. Anesthesia was induced with diazepam 3.75 mg, fentanyl 75 micrograms, thiopental sodium 25 mg and vecuronium 6 mg. Anesthesia was maintained with isoflurane-nitrous oxide-oxygen. From the induction to the end of the operation, dopamine was infused. Increased heart rate and blood pressure were noted for a short time at the induction and at the time of first pneumoperitoneum. Thereafter, no considerable hemodynamic changes occurred. We therefore consider that laparoscopic cholecystectomy under low pressure pneumoperitoneum is appropriate for dilated cardiomyopathy when there is no accompanying heart failure or when only mildly decreased cardiac function exists, such as in this case.
D000768:Anesthesia, General / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008875:Middle Aged