title: [Anesthetic management of a patient with thrombocytopenia induced by methotrexate undergoing emergent clipping surgery].
abstract: A 70-year-old woman underwent emergent clipping surgery for subarachnoid hemorrhage under general anesthesia. Her laboratory data showed thrombocytopenia (4.0 x 10(4) microl(-1)). She had taken prednisolone (3 mg x day(-1)) and methotrexate (MTX) (10 mg x week(-1)) for rheumatoid arthritis for the last 10 years. Anesthesia was induced with remifentanil as well as propofol, maintained with remifentanil and sevoflurane in oxygen. The operation was performed uneventfully without platelet transfusion. Since the cause of thrombocytopenia was suspected to be MTX, we started rescue therapy by calcium folinate postoperatively. Platelet count was normalized two days later (11.6 x 10(4) microl(-1)). One month after the operation, she was discharged uneventfully.
authors.affiliation: Department of Anesthesia, Osaka Kosei-Nenkin Hospital, Osaka 553-0003.
authors.forename: Kuniko
authors.initials: K
authors.lastname: Morishima
authors.forename: Keiji
authors.initials: K
authors.lastname: Nakatani
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Nishi
authors.forename: Akiko
authors.initials: A
authors.lastname: Doi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamama
authors.forename: Mika
authors.initials: M
authors.lastname: Nakanishi
authors.forename: Masami
authors.initials: M
authors.lastname: Yagi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kurita
authors.forename: Noboru
authors.initials: N
authors.lastname: Nagata
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D004630:Emergencies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D002955:Leucovorin / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects*; D010880:Piperidines; D017713:Platelet Transfusion; D011182:Postoperative Care; D015742:Propofol; D000077208:Remifentanil; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D007166:Immunosuppressive Agents; D010880:Piperidines; D000077208:Remifentanil; D002955:Leucovorin; D015742:Propofol; D008727:Methotrexate