Ohno Sho, Niiyama Yukitoshi, Murouchi Takeshi, Yamakage Michiaki
Masui. 2016 May;65(5):526-9.
Severe pulmonary arterial hypertension is a significant risk factor for anesthetic management in patients undergoing even non-cardiac surgery. A 64-year-old female patient with severe pulmonary arterial hypertension was scheduled to undergo inguinal hernioplasty. Preoperative systolic pulmonary arterial pressure was 115 mmHg. We selected monitored anesthesia care with 0.2-0.5 μg x kg(-1) x hr(-1) dexmedetomidine and ultrasound-guided iliohypogastric block. Thereafter, LiDCOrapid was used to acquire the hemodynamic responses during surgery. Continuous iliohypogastric block produced postoperative pain relief and the supplemental analgesic was not needed. The monitored anesthesia care by dexmedetomidine and ultrasound guided continuous iliohypogastric block would be a safe procedure for patients with severe pulmonary arterial hypertension undergoing non-cardiac surgery. LiDCO rapid could be low invasive and useful as a hemodaynamic monitor in such a case.
重度肺动脉高压是即使接受非心脏手术患者麻醉管理的一个重要危险因素。一名64岁患有重度肺动脉高压的女性患者计划接受腹股沟疝修补术。术前收缩期肺动脉压为115mmHg。我们选择采用0.2 - 0.5μg·kg⁻¹·hr⁻¹右美托咪定的监测麻醉管理以及超声引导下腹下神经阻滞。此后，使用LiDCOrapid获取手术期间的血流动力学反应。持续的下腹下神经阻滞产生了术后疼痛缓解，无需补充镇痛药。对于重度肺动脉高压患者接受非心脏手术，右美托咪定监测麻醉管理和超声引导下腹下神经持续阻滞将是一种安全的方法。在这种情况下，LiDCO rapid作为一种血流动力学监测仪可能具有低侵入性且有用。
