title: Difficult anesthesia management in a case of living donor liver transplantation with hypertrophic obstructive cardiomyopathy.
abstract: Liver transplantation with hypertrophic obstructive cardiomyopathy is associated with acute hemodynamic changes, which can exacerbate left ventricular outflow tract obstruction during surgery. Therefore, selection of general anesthetic agents is important, as most can result in hemodynamic instability by reducing systemic vascular resistance and blood pressure. We report successful anesthetic management in a case of living donor liver transplantation with hypertrophic obstructive cardiomyopathy using ketamine, propofol, and fentanyl to avoid vasodilation by anesthetic agents. In addition, landiolol, phenylephrine, and low-dose dopamine were administered to prevent left ventricular outflow tract obstruction, and were found to be effective for improving acute hemodynamic changes during surgery. In the case of this patient, the combination of transesophageal echocardiography and a pulmonary artery catheter was beneficial for intraoperative hemodynamic monitoring.
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan. yrdcn850@yahoo.co.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kusunoki
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuroda
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamoto
mesh_terms: D000758:Anesthesia / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D014694:Ventricular Outflow Obstruction / Q000517:prevention & control