title: [A case of acute myocardial infarction during laparoscopic rectal amputation].
abstract: An 80-year-old man with chronic bronchitis and hypertension was admitted with rectal cancer and cholecystolithiasis. Under general and epidural anesthesia, laparoscopic cholecysytectomy was performed with slightly elevated EtCO2. He underwent head-down tilt for laparoscopic rectectal amputation. Twenty five minutes after positioning, he developed ventricular tachycardia and died. Autopsy showed acute myocardial infarction super-imposed on the scar of lateral wall from old infarction. The laparoscopic operating techniques have become popular, but we do not know the safety limits of the pneumoperitoneal pressure and the angle of head-down tilt position. In our case, the cardiac event occurred 25 minutes after head-down tilt, and the head-down tilt position when combined with pneumoperitoneum may have a fatal influence on high-risk cardiac patients.
authors.affiliation: Department of Anesthesia, Nagano Municipal Hospital, Nagano 381-8511.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hayafuji
authors.forename: Norimasa
authors.initials: N
authors.lastname: Hishinuma
authors.forename: Jumpei
authors.initials: J
authors.lastname: Shibata
authors.forename: Koichi
authors.initials: K
authors.lastname: Ono
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kurato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D017809:Fatal Outcome; D018475:Head-Down Tilt / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000150:complications / Q000601:surgery; D012007:Rectum / Q000601:surgery*