Anesthetic management of hemodialysis-dependent patient for open heart surgery
IIda, T.; Wakayama, S.; Jin, T.; Yamashita, M.; Oyama, T.
Masui. Japanese Journal of Anesthesiology 30(6): 624-629
1981
ISSN/ISBN: 0021-4892 PMID: 7339002 Document Number: 175976
A 31-yr-old male hemodialysis-dependent patient underwent mitral valve replacement. The patient had daily hemodialysis for 3 days before operation. Anesthesia was induced with diazepam, morphine sulfate and pancuronium, and maintained with O2, morphine sulfate supplemented with N2O (50%) and halothane (0.5%) intermittently. Electrolytes, fluids and acid-base balances were maintained as much as possible during operation. Several points were discussed in the anesthetic management of the cardiac patient who had been suffering from chronic renal failure. It appeared important to normalize electrolytes, water balance and uremic metabolites with hemodialysis before operation. During operation, respiratory acidosis, hyperkalemia and A-V shunt occlusion should be avoided and circulatory changes should be kept to a minimum. Anesthetic agents and other drugs must be evaluated from both pathophysiologic changes, metabolism and excretion of drugs in hemodialysis-dependent patients. Septicemia, bacterial endocarditis, effusion and cardiac tamponade are important complications of hemodialysis.