[Anesthetic management of a patient with hemophilia A for left modified Blalock-Taussig shunt].
We gave anesthesia to a patient with hemophilia A for left modified Blalock-Taussig shunt. The patient was a twenty five-day-old boy with pulmonary atresia. We performed the bolus injection test of factor VIII concentrate in preoperative period. His factor VIII activity increased from 9.3 to 113.3% after a bolus injection of 165 units. To keep his factor VIII activity above 80% in perioperative period, a bolus of 125 units of recombinant factor VIII concentrate was injected at anesthesia induction, 125 units 2 hours after the start of the operation, and 125 units 6 hours after the end of the operation. Factor VIII activity 2 hours after anesthesia induction increased only 37.8%, and we had to infuse recombinant factor VIII concentrate additionally. We measured factor VIII activity during operation, and he finally received total of 415 units of factor VIII concentrate. Hydroxyethyl starch infusion, blood transfusion and bleeding in the perioperative period might have caused the factor VIII activity to decrease beyond our expectation. We should infuse factor VIII concentrate properly measuring the factor VIII activity during this operation.
Ejima
Y
Y
Department of Intensive Care Unit, Tohoku University Medical Hospital, Sendai.
Satoh
S
S
Hoshi
K
K
Hasegawa
R
R
Matsukawa
S
S
Hashimoto
Y
Y
D000714:Anastomosis, Surgical; D000768:Anesthesia, General / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation; D005169:Factor VIII / Q000032:analysis; D006467:Hemophilia A / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016343:Monitoring, Intraoperative; D011651:Pulmonary Artery / Q000601:surgery*; D018633:Pulmonary Atresia / Q000150:complications / Q000601:surgery*; D013348:Subclavian Artery / Q000601:surgery*
D005169:Factor VIII