アンギオテンシンII受容体拮抗薬の関与が疑われた術中難治性低血圧の1例

概要

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A case of refractory hypotension due to losartan (angiotensin II receptor antagonist, angiotensin receptor blocker, ARB) is reported. Fifty-two year old fireman was scheduled for the elective operation for open correction of his right fractured upper arm. He had been treated hypertension with losartan, doxazosin and seriprorol. Preoperatively the patient took these pills. After induction of anesthesia, the patient was turned to left lateral decubitus position. On the left lateral position, he suffered from refractory hypotension in spite of large volume of fluid replacement and large doses of ephedrine. There were no signs of hypovolemia or myocardial ischemia. The operation was postponed and re-scheduled on the next day. On the second anesthesia, the patient preoperatively took no medication of these anti-hypertensive drugs and the anesthesia was uneventful. These clinical findings suggest that ARB may induce the refractory hypotension and the careful pre-anesthetic evaluation of circulatory status is necessary in the patient with chronically treated by ARB.
自治医科大学の論文
2004-12-01