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General Anesthetic Management of a Patient With Hypertrophic Cardiomyopathy for Oral Surgery: Did Digitalis Contribute to Bradycardia?

Abstract

Stabilization of circulatory dynamics is a critical issue in the anesthetic management of patients with hypertrophic cardiomyopathy (HCM). In this report, we managed general anesthesia for a 74-year-old male patient with nonobstructive HCM who developed circulatory instability intraoperatively. Severe bradycardia measuring 35 beats/min and hypotension measuring 78 mm Hg systolic were observed during surgery. Using stroke volume variation and stroke volume from the FloTrac as indices, successful circulatory management was performed with dopamine. The hypotension and bradycardia were thought to be the result of methyldigoxin and possibly associated with our perioperative management. Cardiology consult should have been obtained. We demonstrated that the FloTrac can be beneficial in diagnosing and managing cardiovascular instability and administration of dopamine in the anesthetic management of nonobstructive HCM patients.

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  • Authors+Show Affiliations

    ,

    Associate Professor, Department of Anesthesiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan.

    ,

    Resident, Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    ,

    Assistant Professor, Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    ,

    Assistant Professor, Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    ,

    Assistant Professor, Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    ,

    Professor, Department of Oral and Maxillofacial Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    ,

    Professor, Department of Anesthesiology, Aichi Gakuin University School of Dentistry, Nagoya, Japan.

    Professor, Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

    Source

    Anesthesia progress 65:3 2018 pg 192-196

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    30235429

    Citation

    TY - JOUR T1 - General Anesthetic Management of a Patient With Hypertrophic Cardiomyopathy for Oral Surgery: Did Digitalis Contribute to Bradycardia? AU - Sato Boku,Aiji, AU - Morita,Maki, AU - So,MinHye, AU - Tamura,Tetsuya, AU - Sano,Fumiaki, AU - Shibuya,Yasuyuki, AU - Harada,Jun, AU - Sobue,Kazuya, PY - 2019/03/01/pmc-release PY - 2018/9/21/entrez PY - 2018/9/21/pubmed PY - 2018/9/21/medline KW - Circulation management KW - Digitalis KW - Dopamine KW - FloTrac KW - Hypertrophic cardiomyopathy SP - 192 EP - 196 JF - Anesthesia progress JO - Anesth Prog VL - 65 IS - 3 N2 - Stabilization of circulatory dynamics is a critical issue in the anesthetic management of patients with hypertrophic cardiomyopathy (HCM). In this report, we managed general anesthesia for a 74-year-old male patient with nonobstructive HCM who developed circulatory instability intraoperatively. Severe bradycardia measuring 35 beats/min and hypotension measuring 78 mm Hg systolic were observed during surgery. Using stroke volume variation and stroke volume from the FloTrac as indices, successful circulatory management was performed with dopamine. The hypotension and bradycardia were thought to be the result of methyldigoxin and possibly associated with our perioperative management. Cardiology consult should have been obtained. We demonstrated that the FloTrac can be beneficial in diagnosing and managing cardiovascular instability and administration of dopamine in the anesthetic management of nonobstructive HCM patients. SN - 1878-7177 UR - https://www.unboundmedicine.com/medline/citation/30235429/General_Anesthetic_Management_of_a_Patient_With_Hypertrophic_Cardiomyopathy_for_Oral_Surgery:_Did_Digitalis_Contribute_to_Bradycardia L2 - http://www.anesthesiaprogress.org/doi/10.2344/anpr-65-03-12?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed ER -