title: [Anesthetic management for a patient with significant orthostatic hypotension probably due to pure autonomic failure].
abstract: A 73-year-old man with severe orthostatic hypotension was scheduled for open cholecystectomy. His blood pressure was 126/80 mmHg in the supine position and 50/30 mmHg in the upright posture. Preoperative autonomic function tests suggested that postsynaptic fibers of the sympathetic nervous system were impaired, and the disorder was probably due to pure autonomic failure. Anesthesia was induced with thiamylal and vecuronium, and maintained with sevoflurane (3%) and fentanyl (100 microg). Epidural anesthesia was used in the latter half of the operation. Meticulous use of vasoactive drugs such as dopamine and phenylephrine as well as adequate maintenance of systemic blood volume by infusion of a crystalloid solution enabled his hemodynamic condition to become stable during anesthesia.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka 812-8582.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tokuda
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Motoyama
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Kai
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Sumio
authors.initials: S
authors.lastname: Hoka
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D002763:Cholecystectomy; D000077324:Crystalloid Solutions; D004298:Dopamine / Q000008:administration & dosage; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology*; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D019990:Perioperative Care; D010656:Phenylephrine / Q000008:administration & dosage; D054970:Pure Autonomic Failure / Q000150:complications*
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010656:Phenylephrine; D004298:Dopamine