title: [Anesthetic management of heart transplantation].
abstract: We anesthetized a 47-yr-old man with end-stage hypertrophic cardiomyopathy for heart transplantation. This is the first case of heart transplantation from a patient with brain death, since the organ transplantation law had become valid in Japan. Anesthesia was induced and maintained with fentanyl and diazepam. Aseptic technique was used in inserting and securing all catheters. The patient was assisted by left ventricular assist system, and hemodynamic suppression at anesthetic induction was trivial. Since complete AV block was present at the termination of cardiopulmonary bypass (CPB), VVI pacing and infusion of isoproterenol were started. In addition, nitroglycerin was given for pulmonary vasodilation. The cardiovascular support used for weaning from CPB included dobutamine, isoprote-renol, dopamine and milrinone. Following weaning from CPB sinus rhythm appeared spontaneously and function of the transplanted heart was satisfactory. When the patient was transported to ICU reduction in doses of catecholamines was possible, and dopamine and milrinone were infused. The patient was extubated 10 hours after admission to ICU.
authors.affiliation: Department of Anesthesiology, Osaka University Faculty of Medicine, Suita.
authors.forename: Y
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Y
authors.initials: Y
authors.lastname: Hayashi
authors.forename: M
authors.initials: M
authors.lastname: Imai
authors.forename: A
authors.initials: A
authors.lastname: Fukuchi
authors.forename: R
authors.initials: R
authors.lastname: Matsutani
authors.forename: M
authors.initials: M
authors.lastname: Takashina
authors.forename: H
authors.initials: H
authors.lastname: Ueyama
authors.forename: K
authors.initials: K
authors.lastname: Abe
authors.forename: T
authors.initials: T
authors.lastname: Mashimo
authors.forename: Y
authors.initials: Y
authors.lastname: Ohnishi
authors.forename: M
authors.initials: M
authors.lastname: Kuro
mesh_terms: D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001424:Bacterial Infections / Q000517:prevention & control; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002404:Catheterization / Q000379:methods; D003975:Diazepam; D005283:Fentanyl; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control
chemical_list: D018686:Anesthetics, Intravenous; D003975:Diazepam; D005283:Fentanyl