一名患有甲基苯丙胺相关性肺动脉高压的患者行腹腔镜胆囊切除术的麻醉管理

Anesthetic management of a patient with methamphetamine-associated pulmonary arterial hypertension undergoing laparoscopic cholecystectomy.

作者信息

Oshita Kensuke, Tokuyama Shin, Jotaki Shosaburo, Yokomizo Michiko, Hiraki Teruyuki

机构信息

Department of Anesthesiology, Kurume University School of Medicine, 67 Asahi-Machi, Kurume, Fukuoka, 830-0011, Japan.

出版信息

JA Clin Rep. 2023 Feb 20;9(1):10. doi: 10.1186/s40981-023-00601-3.

DOI:10.1186/s40981-023-00601-3

PMID:36801985

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9939558/

Abstract

BACKGROUND

Methamphetamine abuse is a serious public health concern and causes various life-threatening disorders including pulmonary arterial hypertension (PAH). Herein, we present the first case report describing the anesthetic management of a patient with methamphetamine-associated PAH (M-A PAH) undergoing laparoscopic cholecystectomy.

CASE PRESENTATION

A 34-year-old female with M-A PAH suffered from deterioration of right ventricular (RV) heart failure due to recurrent cholecystitis and was scheduled for laparoscopic cholecystectomy. Preoperative assessment of PA pressure showed 82/32 (mean, 50) mmHg, and transthoracic echocardiology revealed a slight reduction of RV function. General anesthesia was induced and maintained by thiopental, remifentanil, sevoflurane, and rocuronium. PA pressure gradually increased after peritoneal insufflation; therefore, we administered dobutamine and nitroglycerin to decrease pulmonary vascular resistance (PVR). The patient emerged from anesthesia smoothly.

CONCLUSIONS

Avoiding increased PVR by appropriate anesthesia and medical hemodynamic support is an important consideration for patients with M-A PAH.

摘要

背景

甲基苯丙胺滥用是一个严重的公共卫生问题，可导致包括肺动脉高压（PAH）在内的各种危及生命的疾病。在此，我们报告首例关于一名患有甲基苯丙胺相关性PAH（M-A PAH）的患者接受腹腔镜胆囊切除术的麻醉管理的病例报告。

病例介绍

一名患有M-A PAH的34岁女性因复发性胆囊炎导致右心室（RV）心力衰竭恶化，计划行腹腔镜胆囊切除术。术前PA压力评估显示为82/32（平均50）mmHg，经胸超声心动图显示RV功能略有下降。采用硫喷妥钠、瑞芬太尼、七氟醚和罗库溴铵诱导并维持全身麻醉。气腹后PA压力逐渐升高；因此，我们给予多巴酚丁胺和硝酸甘油以降低肺血管阻力（PVR）。患者顺利苏醒。