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Anesth Analg 2004;99:438-439
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000121960.22554.D7

ANESTHETIC PHARMACOLOGY

Anesthetic Management of Patients with Severe Peripheral Ischemia Due to Calciphylaxis

Takafumi Horishita, MD PhD, Kouichiro Minami, MD PhD, Junichi Ogata, MD PhD, and Takeyoshi Sata, MD PhD

Department of Anesthesiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

Address correspondence and reprint requests to Kouichiro Minami, MD, PhD, Department of Anesthesiology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu 807-8555, Japan. Address e-mail to kminami{at}med.uoeh-u.ac.jp

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 E1 (PGE1) 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 PGE1 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 PGE1 throughout anesthesia. Monitoring by laser Doppler blood flowmetry and PGE1 20 ng · kg–1 · min–1 could be useful for patients with impaired peripheral circulation, as in calciphylaxis.

IMPLICATIONS: We managed a patient with calciphylaxis during anesthesia by using laser Doppler blood flowmetry and infusion of prostaglandin E1. This management procedure is useful for patients with calciphylaxis and severely impaired peripheral circulation.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2004 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.