Anesthetic Management in a Patient with Dilated Phase of Hypertrophic Cardiomyopathy for Robot-Assisted Radical Cystectomy

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  • IWASAKI Naoya
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • TSUJI Chikako
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • HIGASHIJIMA Ushio
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • MURATA Hiroaki
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • YOSHITOMI Osamu
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences
  • HARA Tetsuya
    Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences

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  • 拡張相肥大型心筋症患者に対するロボット支援根治的膀胱全摘除術の麻酔経験

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<p>Robot-assisted radical total cystectomy is considered less invasive than open cystectomy with fewer postoperative complications. However, the steep Trendelenburg position and pneumoperitoneum required in these cases may precipitate significant intraoperative circulatory changes, and patients with low cardiac function show a high risk of heart failure. We report the case of a 74-year-old man diagnosed with the dilated phase of hypertrophic cardiomyopathy who was scheduled to undergo robotic-assisted total cystectomy for bladder cancer. Using a pulmonary artery catheter and transesophageal echocardiography, we preoperatively evaluated the effects of the steep Trendelenburg position required for this operation on circulatory dynamics and decided that the operation could be performed in a 25° head-down position. Intraoperatively, we administered sufficient muscle relaxant to ensure that the operation could be safely performed with a minimum head-down angle, and he underwent the procedure successfully without circulatory collapse. The patient showed an unremarkable postoperative course with strict monitoring of circulatory dynamics and was transferred to the hospital on the ninth postoperative day.</p>

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