title: [Anesthetic management of a patient with acute idiopathic pandysautonomia].
abstract: Acute idiopathic pandysautonomia (AIPD) is a very rare disease with acute onset of impairment in the peripheral sympathetic and parasympathetic nerves. We report the anesthetic management of a patient with AIPD undergoing bladder lithotomy and scrotum abscess drainage. A 64-year-old man had a severe orthostatic hypotension, and was extremely sensitive to intravenous norepinephrine because of denervation hypersensitivity. Before the surgery, the patient was sufficiently hydrated. We planned to administer a vasopressor (phenylephrine) and a vasodilator (nicardipine) at 1/10 of usual doses. After placement of a radial artery catheter, combined epidural and spinal anesthesia was performed with the patient in a right lateral position. Blood pressure decreased slightly after placing him in a supine position. However, no medication was needed, and the patient showed no perioperative complications.
authors.affiliation: Department of Anesthesiology, Tsukuba University Hospital, Tsukuba 305-8576.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Miyabe
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyooka
mesh_terms: D000038:Abscess / Q000209:etiology / Q000601:surgery; D000208:Acute Disease; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D001342:Autonomic Nervous System Diseases / Q000150:complications; D004322:Drainage; D005832:Genital Diseases, Male / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage; D019990:Perioperative Care; D010656:Phenylephrine / Q000008:administration & dosage; D011187:Posture; D012611:Scrotum; D001744:Urinary Bladder Calculi / Q000209:etiology / Q000601:surgery; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D010656:Phenylephrine; D009529:Nicardipine