Congestive Heart Failure after Induction of General Anesthesia in a Patient with Undiagnosed Dilated Cardiomyopathy.
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A 75-year-old male had emergency ophthalmic surgery under general anesthesia. Preoperatively, his chest X-P revealed mild cardiomegaly and an ECG showed atrial fibrillation. Upon arrival at the operating theater, it was found that supraventricular tachyarrhythmia had developed. Valsalvas maneuver, carotid sinus massage and intravenous administration of verapamil were not effective. Anesthesia was induced with 125mg of thiamylal followed by vecuronium, and maintained with 50% O2-N2O-1% sevoflurane. A few minutes after endotracheal intubation, his blood pressure and pulse oxymeter oxygen saturation decreased. Congestive heart failure was diagnosed by a chest X-P and hemodynamic assessment with a pulmonary artery catheter. After administration of an inotropic agent, his blood pressure and arterial oxygenation improved gradually. ECG showed the return to a normal sinus rhythm after treatments with bolus administration of ATP and cardioversion. Surgery was postponed and the echocardiogram revealed dilated ventriculus and gross impairment of ventricular systolic function, with suspected dilated cardiomyopathy. We conclude that preoperative evaluation of cardiac function is essential in a patient in whom cardiovascular abnormality is suspected.
- 日本臨床麻酔学会の論文
日本臨床麻酔学会 | 論文
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