[Anesthetic experience of emergency coronary artery bypass graft operation in a patient with cardioamyloidosis].
A 76-year-old woman with acute myocardial infarction underwent an emergency coronary artery bypass graft operation. She developed cardiac failure and sick sinus syndrome before the surgery because she was with cardioamyloidosis. Therefore, intra-aortic balloon pumping and the pacemaker were used to maintain the hemodynamics prior to the operation. Anesthesia was induced with midazolam 5 mg, morphine 30 mg and pancuronium 5 mg, and maintained with 0.3-0.5% isoflurane in 50% nitrous oxide and 50% oxygen. Morphine 10 mg was also injected during the surgery, and the total dose of morphine 40 mg was administered. The pacemaker at 80 bpm was inserted and mexiletine 0.5 mg.kg-1.h-1 was given to prevent ventricular arrhythmias at weaning from cardio-pulmonary bypass. The surgical operation was successfully performed and the postoperative course was uneventful. A combination of light inhalation anesthesia with narcotics may be a choice for anesthetic management of patients with cardioamyloidosis as this method has less influence on hemodynamics.
Fukagawa
D
D
First Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi 321-0293.
Yamaguchi
S
S
Hamaguchi
S
S
Mishio
M
M
Okuda
Y
Y
Kitajima
T
T
D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D000769:Anesthesia, Inhalation; D009202:Cardiomyopathies / Q000150:complications*; D002395:Catecholamines / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D004630:Emergencies; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D009020:Morphine / Q000008:administration & dosage; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D009294:Narcotics / Q000008:administration & dosage; D010138:Pacemaker, Artificial; D019990:Perioperative Care; D016896:Treatment Outcome
D002395:Catecholamines; D009294:Narcotics; D009020:Morphine