Anesthetic management of a patient with Bartter's syndrome.
Bartter's syndrome is a rare disorder characterized by normal or low arterial blood pressure (BP), despite marked elevation in plasma renin activity, angiotensin II (Ang-II), and aldosterone, along with hypokalemic metabolic alkalosis. Perioperative changes in the cardiovascular and renin-angiotensin-aldosterone (RAA) systems in Bartter's syndrome patients are not well understood. We managed a 44-year-old Japanese man with rectal cancer and Bartter's syndrome complicated by renal dysfunction. He underwent anterior resection of the rectum with general anesthesia (50% nitrous oxide-oxygen with 0.5% to 0.8% isoflurane, supplemented with intravenous midazolam and butorphanol). Epidural morphine was given postoperatively. Although BP tended to be lower (75/35 to 110/60 mmHg) during surgery, there were no profound perioperative hemodynamic derangements. Plasma renin activity. Ang-II, and aldosterone values were highest during surgery. These responses of the RAA system to anesthesia and surgery were the same as previously noted in otherwise healthy surgical patients.
Higa
K
K
Department of Anesthesiology, School of Medicine, Fukuoka University, Japan.
Ishino
H
H
Sato
S
S
Dan
K
K
D000328:Adult; D000450:Aldosterone / Q000097:blood; D000769:Anesthesia, Inhalation; D000804:Angiotensin II / Q000097:blood; D001477:Bartter Syndrome / Q000150:complications*; D006801:Humans; D007530:Isoflurane; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D009609:Nitrous Oxide; D010100:Oxygen; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery*; D012083:Renin / Q000097:blood
D000804:Angiotensin II; D000450:Aldosterone; D007530:Isoflurane; D012083:Renin; D009609:Nitrous Oxide; D010100:Oxygen