Anesthetic management of patients with severe peripheral ischemia due to calciphylaxis.

Abstract

Calciphylaxis is a small-vessel disease associated with renal failure. Here, we report the management of a 43-yr-old man with calciphylaxis who received left lower leg amputation with prostaglandin E(1) (PGE(1)) under monitoring by laser Doppler blood flowmetry in the left second and third fingers. Anesthesia was induced with midazolam, fentanyl, and vecuronium and was maintained with oxygen, nitrous oxide, and sevoflurane. The peripheral blood flow varied and decreased gradually; therefore, we added PGE(1) 20 ng. kg(-1). min(-1), which increased blood flow of the tissues. Three weeks after the operation, we again anesthetized the patient. We maintained the blood flow with PGE(1) throughout anesthesia. Monitoring by laser Doppler blood flowmetry and PGE(1) 20 ng. kg(-1). min(-1) could be useful for patients with impaired peripheral circulation, as in calciphylaxis.

• Authors: Takafumi Horishita, Kouichiro Minami, Junichi Ogata, Takeyoshi Sata
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 99 Issue 2 Pg. 438-9, table of contents (Aug 2004) ISSN: 0003-2999 [Print] United States
• PMID: 15271720 (Publication Type: Case Reports, Journal Article)

Chemical References

• Vasodilator Agents
• Alprostadil

Topics

• Adult
• Alprostadil (therapeutic use)
• Amputation, Surgical
• Anesthesia
• Calciphylaxis (complications)
• Fingers (pathology)
• Foot (pathology)
• Humans
• Ischemia (complications, drug therapy, etiology)
• Kidney Failure, Chronic (complications)
• Laser-Doppler Flowmetry
• Male
• Necrosis
• Oximetry
• Vasodilator Agents (therapeutic use)