Anesthetic management of patients with severe peripheral ischemia due to calciphylaxis.
Calciphylaxis is a small-vessel disease associated with renal failure. Here, we report the management of a 43-yr-old man with calciphylaxis who received left lower leg amputation with prostaglandin E(1) (PGE(1)) under monitoring by laser Doppler blood flowmetry in the left second and third fingers. Anesthesia was induced with midazolam, fentanyl, and vecuronium and was maintained with oxygen, nitrous oxide, and sevoflurane. The peripheral blood flow varied and decreased gradually; therefore, we added PGE(1) 20 ng. kg(-1). min(-1), which increased blood flow of the tissues. Three weeks after the operation, we again anesthetized the patient. We maintained the blood flow with PGE(1) throughout anesthesia. Monitoring by laser Doppler blood flowmetry and PGE(1) 20 ng. kg(-1). min(-1) could be useful for patients with impaired peripheral circulation, as in calciphylaxis.
Department of Anesthesiology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu 807-8555, Japan. kminami@med.uoeh-u.ac.jp
Takafumi
T
Horishita
Kouichiro
K
Minami
Junichi
J
Ogata
Takeyoshi
T
Sata
D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use*; D000671:Amputation, Surgical; D000758:Anesthesia; D002115:Calciphylaxis / Q000150:complications*; D005385:Fingers / Q000473:pathology; D005528:Foot / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000188:drug therapy* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications; D017078:Laser-Doppler Flowmetry; D008297:Male; D009336:Necrosis; D010092:Oximetry; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D000527:Alprostadil