Measuring and maintaining organ perfusion in a patient with Takayasu's arteritis undergoing cardiac surgery.

Autor: Dan K; Department of Anaesthesia Tokyo Bay Urayasu Ichikawa Medical Center Chiba Japan., Takahashi K; Department of Anaesthesia Jichi Medical University Saitama Medical Center Saitama Japan., Lefor AK; Department of Surgery Jichi Medical University Tochigi Japan.
Jazyk: angličtina
Zdroj: Anaesthesia reports [Anaesth Rep] 2023 Jul 04; Vol. 11 (2), pp. e12236. Date of Electronic Publication: 2023 Jul 04 (Print Publication: 2023).
DOI: 10.1002/anr3.12236
Abstrakt: Takayasu's arteritis is a rare vasculitis affecting the aorta and its branches. Disease progression can result in arterial stenosis and subsequent organ dysfunction. Estimating organ perfusion by measuring the peripheral blood pressure can be challenging because it may be altered by arterial stenosis. We report the case of a 61-year-old woman with Takayasu's arteritis with aortic and mitral regurgitation who presented for aortic valve replacement and mitral valvuloplasty. Peripheral arterial pressure was considered a less reliable surrogate for organ perfusion because the patient had diminished blood flow in both the lower and upper extremities. In addition to the bilateral radial arterial pressure, the blood pressure in the ascending aorta was monitored to estimate the patient's organ perfusion pressure during cardiopulmonary bypass. The initial target blood pressure was determined based on the pre-operative baseline and modified by measurement of the aortic pressure. Cerebral oximetry using near-infrared spectroscopy and mixed venous saturation was monitored to estimate oxygen supply-demand balance, which helped evaluate cerebral perfusion and determine the transfusion threshold. The entire procedure was uneventful, and no organ dysfunction was observed postoperatively.
(© 2023 The Authors. Anaesthesia Reports published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
Databáze: MEDLINE
Externí odkaz: