[Surface-induced mild hypothermia anesthesia for hepatectomy in a patient with a giant hemangioma of the liver (Kasabach-Merritt syndrome)].
A 63-year-old woman presenting with thrombocytepenia and signs of intravascular coagulation (prothronbin time, 59%: FDP, 100 micrograms.ml-1) due to a giant hemangioma of the liver (Kasabach-Merritt syndrome) was scheduled for the resection of the right lobe of the liver. In order to protect the liver on occlusion of the right hepatic artery and portal vein, we induced mild hypothermia technique with vasodilation and surface cooling by convecting warming device together with hepatoprotective agents of PGE1 and ulinastatin. Severe, acute massive bleeding occurred due to the injury of the middle hepatic vein and from the resected surface of the liver. Her rectal temperature was 31.9 degrees C during massive bleeding. Her hemoglobin decreased to 3.9 g.dl-1. Total estimated blood loss was 22,000 ml. The weight of the resected liver was 2.5 kg. The maximum postoperative levels of T-Bil and GOT were 2.47 mg.dl-1 and 171 IU.l-1, respectively. The liver seemed to have been well preserved and no other complications were observed. The hemangioma was completely removed by excision of the right lobe of the liver. Subsequently, all coagulation parameters returned to normal, indicating a complete reversibility of the coagulopathy. Surface-induced mild hypothermia is a useful and valuable method for protecting the liver during severe massive bleeding.
Wake
M
M
Department of Anesthesia, St. Mary's Hospital, Himezi.
Okamoto
Y
Y
Sanagawa
Y
Y
D000768:Anesthesia, General; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006391:Hemangioma / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D013577:Syndrome; D013921:Thrombocytopenia / Q000209:etiology