[An anesthetic experience of a patient with congestive cardiomyopathy].

A 54 year-old man with congestive cardiomyopathy underwent total cystectomy with formation of ileal conduit under fentanyl anesthesia. Preoperative status was evaluated to be very risky with ASA 3, Goldman cardiac risk index 28 and NYHA 3. Cardiac function was evaluated with Swan-Ganz catheter during anesthesia with fentanyl (30 mcg.kg-1) and 60% nitrous oxide. Dopamine, dobutamine and vasodilators (prostaglandin E1, trinitroglycerin) were continuously infused intravenously to decrease high afterload and enhance diminished cardiac contractility. On the 7th post-operative day, massive atelectasis in the right lung was observed, which was improved by positive pressure ventilation and vigorous bronchial lavage. A careful management with meticulous anesthetic care is emphasized for patients with congestive cardiomyopathy.