title: [Combination of spinal and inhalation anesthesia for nephrectomy in a cirrhotic patient].
abstract: We report a 75-year-old man with the liver cirrhosis of Child-Pugh B who underwent nephrectomy. Preoperative serum examination revealed increases in GOT, GPT, LDH and total bilirubin, decreases in cholinesterase and albumin, and prolongation of prothrombin time. We selected spinal anesthesia using bupivacaine and fentanyl rather than epidural anesthesia in combination with isoflurane inhalation anesthesia to supplement intra-operative anesthesia and post-operative pain relief. We explained the risks of blood coagulopathy and the predictable venous dilatation in the epidural space to the patient and relatives on obtaining informed consent. The surgery was completed uneventfully in 2.5 hours. Post-operative pain control was satisfactory and hepatic dysfunction did not deteriorate in the postoperative period.
authors.affiliation: Department of Anesthesiology, Kurume University School of Medicine, Kurume 830-0011.
authors.forename: Maiko
authors.initials: M
authors.lastname: Sawada
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Kono
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kano
mesh_terms: D000368:Aged; D000527:Alprostadil; D000769:Anesthesia, Inhalation; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002045:Bupivacaine; D004298:Dopamine; D005283:Fentanyl; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D009392:Nephrectomy; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care
chemical_list: D000779:Anesthetics, Local; D000527:Alprostadil; D005283:Fentanyl; D004298:Dopamine; D002045:Bupivacaine