We report a case of perioperative management of a 93 year-old patient with aortic stenosis and ischemic heart disease resulting in myocardial ischemia after operation. The patient was diagnosed with cancer of right mandibular gingiva and was scheduled for right mandibular block resection and reconstruction with a plate. Although she was diagnosed as having moderate aortic stenosis, moderate mitral valve regurgitation, and silent ischemic heart disease in preoperative examination, her cardiac function was considered to be normal on the basis of an ultrasonic echocardiogram. No premedication was administered. ECG monitoring and peripheral hemoglobin-oxygen saturation monitorings were established. A cuff of automated blood pressure measurement was placed on the right arm and set to record at 2.5-minute intervals. Nitroglycerine was infused intravenously at 0.5-1.0 μg/kg/min before, during, and after surgery. Anesthesia was induced by intravenous administration of 10 mg of midazolam, 4 mg of vecuronium, and 0.3 mg of fentanyl. The trachea was easily intubated with a 7.0 mm cuffed endotracheal tube. After the nasotracheal intubation, the lungs were ventilated with 60% nitrous oxide in oxygen. Before skin incision, 2% xylocaine 15 ml was infiltrated at the surgical area. During surgery, 0.3 mg of fentanyl was administered intermittently before tumor resection. Surgery was performed uneventfully. In spite of her advanced age, she recovered clearly from general anesthesia on administration of naloxone. After extubation, because the blood pressure was 220/120 mmHg, nicardipine was administered intravenously. Then, the blood pressure was decreased to 130/58 mmHg, resulting in ST depression with premature ventricular contractions (PVC) (Fig. 1 B). After blood pressure was recovered to 150/72 with lifting her legs, the ST change disappeared (Fig. 1 C). The next day, since her ST change appeared again, beta blocker was administered orally. She got a good clinical course and was discharged after 24 postoperative days.
|ジャーナル||Journal of Japanese Dental Society of Anesthesiology|
|出版ステータス||Published - 2004 5月 26|
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