[Mild hypothermia anesthesia for carotid microendoarterectomy in a patient with ischemic heart disease].
A 69 year-old male with ischemic heart disease indicated for coronary artery bypass grafting was scheduled for carotid microendoarterectomy. We induced mild hypothermia technique with vasodilation and surface cooling by convecting warming device. We examined hemodynamics by pulmonary artery catheter. Anesthesia was induced with thiamylal, fentanyl, midazolam and isoflurane in nitrous oxide and oxygen. Following administration of vecuronium, trachea was intubated. Pulmonary artery catheter was inserted from the femoral vein. Dopamine, dobutamine 3-5 micrograms.kg-1.min-1 and PGE1 5-10 ng.kg-1.min-1 were continuously administered to keep peripheral blood circulation and cardiac output (CO). Systemic vascular resistance decreased from 1800 to 591 dyne.s.cm-5 and CO increased from 2.8 to 6.9 l.min-1. The occlusion of blood flow of the right carotid artery for 40 min at 34.5 degrees C of rectal temperature did not cause any neurological deficits. No other complications such as arrhythmia, myocardial ischemia and bleeding tendency were observed. Keeping peripheral blood circulation and uniform cooling and warming are important in inducing mild hypothermia safely in a patient with ischemic heart disease.
Unetani
H
H
Division of Anesthesia and Intensive Care Medicine, Hiroshima Prefectural Hiroshima Hospital.
Nakao
M
M
Kawaguchi
R
R
Nakatani
K
K
Hazama
K
K
Kajiyama
S
S
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000601:surgery*; D004280:Dobutamine / Q000008:administration & dosage; D004298:Dopamine / Q000008:administration & dosage; D016894:Endarterectomy, Carotid; D006801:Humans; D007036:Hypothermia, Induced; D007430:Intraoperative Care; D008297:Male; D008866:Microsurgery; D017202:Myocardial Ischemia / Q000150:complications*
D002316:Cardiotonic Agents; D004280:Dobutamine; D004298:Dopamine