Contribution of Adequate Preoperative Circulatory Management to Uneventful Perioperative Course of Transurethral Resection of a Bladder Tumor for a Patient with Hypertrophic Obstructive Cardiomyopathy
| Autor: | Kimura, Haruka, Sugano, Takayuki, Uzawa, Masashi, Kimura, Rie, Sato, Kanako, Koda, Kenichiro, Kitamura, Takayuki |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: | |
| Zdroj: | Toho Journal of Medicine. 5(2):76-83 |
| ISSN: | 2189-1990 |
| Popis: | Case Report In noncardiac surgery for patients with hypertrophic obstructive cardiomyopathy (HOCM), there is no safety criterion of the left ventricular outflow tract (LVOT) gradient and no standardized anesthetic management. Transurethral resection of bladder tumor (TUR-Bt) was scheduled for a 67-year-old man with HOCM. Because the LVOT gradient at rest was 81 mmHg, we postponed the surgery and initiated preoperative pharmacological therapy for HOCM using carvedilol and cibenzoline. The LVOT gradient at rest decreased to 41 mmHg, and then TUR-Bt was rescheduled. Spinal anesthesia in combination with obturator nerve block was chosen for anesthetic management, and arterial blood pressure was continuously monitored. The surgery and postoperative course were uneventful. After the surgery, the patient underwent percutaneous transluminal septal myocardial ablation (PTSMA), by which the LVOT gradient at rest decreased to 3 mmHg. We suppose that adequate control of the LVOT gradient is essential in the management of noncardiac surgery for patients with HOCM. |
| Databáze: | OpenAIRE |
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