A 51-year-old man with
dilated cardiomyopathy, who had been treated with medication for five years, was scheduled for abdomioperineal resection of the rectum. Preoperative echocardiography demonstrated left ventricular dilation and
hypertrophy, with an ejection fraction of 0.34.
Anesthesia was induced with
ketamine 40 mg and
fentanyl 0.5 mg intravenously. Endotracheal intubation was facilitated by administration of
vecuronium 10 mg.
Anesthesia was maintained with
nitrous oxide-
oxygen-
sevoflurane and
fentanyl. In order to regulate myocardial contractility and after-load, use of a
phosphodiesterase III inhibitor was considered, although
phosphodiesterase III inhibitors are known to induce arrhythmias, which should be avoided in
dilated cardiomyopathy patients. We chose
olprinone, because its inotropic action is not associated with arrhythmogenecity. Before infusing
olprinone, cardiac output was 4.5 l.min-1 and systemic vascular resistance was 1306 dynes.sec.cm-5. When
olprinone was continuously infused for one hour, cardiac output increased to 5.2 l.min-1 and systemic vascular resistance decreased to 958 dynes.sec.cm-5. Some
premature ventricular contractions occurred, but they were easily controlled by administration of 50 mg
lidocaine. These clinical data demonstrate that
olprinone enhanced myocardial contractility, and decreased after-load and arrhythmogenecity in a
dilated cardiomyopathy patients. In conclusion,
olprinone is useful in the perioperative cardiovascular management of surgical patients with
dilated cardiomyopathy.