Anesthetic Management of a Patient with Antiphospholipid Antibody Syndrome: A case report / 대한마취과학회지

The antiphospholipid antibody syndrome (APS) is characterized by the presence of auto antibodies to phospholipids in association with in vitro prolongation of phospholipid-dependent coagulation tests, recurrent pregnancy loss, multiple thrombotic events, etc. Due to strong predilection for thrombosis in both the arterial and venous system, perioperative thromboprophylaxis for APS patients is very important to avoid catastrophic major cardiovascular complications. We experienced general anesthesia for a total abdominal hysterectomy in a 47-year-old patient diagnosed as having APS by a past medical history of deep vein thrombosis, fetal wastages, and laboratory confirmation. Pre and postoperative management for hypercoagulability was done with oral warfarin and low dose heparin. To prevent intraoperative thrombosis, we maintained an activated clotting time (ACT) over 200 seconds by heparin 3000 U injection, applied antithrombotic stockings, and tried to avoid dehydration, hypothermia and infections.

Comparision of the Hemodynamic Effects of Dopamine and Milrinone in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting / 대한마취과학회지

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) on the beating heart causes hemodynamic compromise during displacement of the heart for graft anastomosis. To overcome hemodynamic unstability, volume loading, Trendelenburg position, inotropic and vasodilator supports etc. are selected as usual. This study was designed to compare the hemodynamic effects of milrinone and dopamine on OPCAB anesthesia. METHODS: Twenty patients (13 men, 7 women; mean age 63.4 +/- 18.2 years old) who underwent OPCAB were enrolled in this study. The patients were randomly placed in a dopamine group (n = 10) and in a milrinone group (n = 10). Basic doses of each drug was administered during left anterior descending artery (LAD), posterior descending arterty (PDA), and left circumflex artery territory (LCX) anastomosis. Hemodynamic variables such as; heart rate (HR), mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) were collected before mechanical stabilization (T1), during anastomosis (T2), and 5 minutes after anastomosis (T3) of LAD and LCX in each patient. RESULTS: During LAD anastomosis, HR in the D group increased significantly at T2 (12.6%(upword arrow)) and T3 (9.8%(upword arrow)) but didn't show significant changes in the M group. CI in the M group showed significant increase at T3 (21.7%(upword arrow) compared to T3 and 18.0%(upword arrow) compared to the D group). During LCX anastomosis, HR didn't show significant changes in the M group, MAP in the D group showed significant decrease (19.3%) at T2 but it was insignificant in the M group. MPAP and PVR showed significant increase at T2 in the D group compared to T1 and T2 in the M group. PCWP showed similar changes of PVR during LCX anastomosis CONCLUSIONS: Hemodynamic changes during OPCAB are more remarkable during LCX anastomosis than LAD anastomosis. These changes can be successfully relieved by inotropic supports with continuos milrinone infusion during anastomosis.