title: [General anesthesia for a patient with Noonan's syndrome and long-term antidepressant therapy].
abstract: Noonan's syndrome is associated with cardiovascular, spinal and airway abnormalities. We experienced general anesthesia for a patient with Noonan's syndrome and long-term antidepressant therapy. A 42-year-old man was scheduled for radical operation for ventral hernia. He had been diagnosed as Noonan's syndrome by his facial and spinal abnormalities. He was intubated under bronchofiberscopy for his previous general anesthesia. He had received amitriptyline 50 mg daily for ten years. Anesthesia was induced with midazolam 3 mg, fentanyl 50 microg, droperidol 1.25 mg. He was intubated under bronchofiberscopy after topical lidocaine 400 mg application. Then thiopental 125 mg and sevoflurane 0.4% was administered. Blood pressure decreased after intubation to 70/40 mmHg, which was resistant to ephedrine 10 mg. After starting surgery, blood pressure increased to 100/70 mmHg and was stable until the end of surgery. This patient presented a problem of difficult intubation as Noonan's syndrome and had a history of a long-term use of antidepressant, which might induce sympathomimetic resistant hypotension.
authors.affiliation: Department of Anesthesiology, The University of Tokyo, Faculty of Medicine, Tokyo 113-8655.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kenji
authors.initials: K
authors.lastname: Takeda
authors.forename: Tomoki
authors.initials: T
authors.lastname: Nishiyama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hanaoka
mesh_terms: D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage / Q000009:adverse effects*; D000768:Anesthesia, General; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004351:Drug Resistance; D004809:Ephedrine / Q000627:therapeutic use; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology; D007442:Intubation, Intratracheal; D008297:Male; D009634:Noonan Syndrome / Q000150:complications; D013566:Sympathomimetics / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents; D013566:Sympathomimetics; D000639:Amitriptyline; D004809:Ephedrine