PMID- 9691592
OWN - NLM
STAT- MEDLINE
DCOM- 19980908
LR  - 20061115
IS  - 0021-4892 (Print)
IS  - 0021-4892 (Linking)
VI  - 47
IP  - 6
DP  - 1998 Jun
TI  - [Perioperative management for nephrectomy in a long-term hemodialysis patient 
      with anticoagulants for coronary stent].
PG  - 720-5
AB  - A 53-year old man on long-term hemodialysis (HD) with anticoagulant therapy was 
      scheduled for nephrectomy due to renal cell carcinoma. Two months before surgery, 
      a coronary stent had been placed due to right coronary artery disease. One week 
      before surgery, percutaneous transmural coronary angioplasty (PTCA) was performed 
      for unstable angina. Aggressive oral antiplatelet therapy (aspirin and 
      ticlopidine) was absolutely required to maintain patency. Following withdrawal of 
      the antiplatelets, unfractionated heparin (UFH) was titrated to an activated 
      partial thromboplastin time (APTT) of 1.5 times greater than the control value. 
      Maintenance UFH (800 U.h-1) was continued until the time of arrival in the 
      operation room (activated clotting time (ACT) was 166 seconds). One hour after 
      arrival, reduced dose of UFH (200 U.h-1) was reinfused, and ACT was 121 140 
      seconds. Hemodynamic change was minimized using balanced general anesthesia 
      (nitrous oxide-isoflurane, fentanyl, midazolam and vecuronium) accompanied by 
      nitroglycerin and diltiazem. There was no ischemic change on ECG or 
      transesophageal echocardiography. Following surgery, the UFH dose was augmented 
      (400 U.h-1), and the maintenance dose was attained 11 hours after surgery. HD on 
      the second postoperative day was performed uneventfully. This hemodynamic 
      stability might be come from the no water removal. Fourteen days after surgery, 
      the patient was discharged without hemorrhagic complications or clinical ischemic 
      events. We conclude that perioperative UFH infusion is not contraindicated for 
      dialysis patient if strict ACT control is maintained.
FAU - Tabuchi, Y
AU  - Tabuchi Y
AD  - Department of Anesthesia, Nagahama City Hospital.
FAU - Nosaka, S
AU  - Nosaka S
FAU - Amakata, Y
AU  - Amakata Y
FAU - Takamitsu, Y
AU  - Takamitsu Y
FAU - Shibata, N
AU  - Shibata N
LA  - jpn
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - Masui
JT  - Masui. The Japanese journal of anesthesiology
JID - 0413707
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Carcinoma, Renal Cell/surgery/therapy
MH  - Coronary Disease/therapy
MH  - *Coronary Vessels
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Kidney Neoplasms/surgery/therapy
MH  - Male
MH  - Middle Aged
MH  - *Nephrectomy
MH  - *Renal Dialysis
MH  - *Stents
EDAT- 1998/08/06 00:00
MHDA- 1998/08/06 00:01
CRDT- 1998/08/06 00:00
PHST- 1998/08/06 00:00 [pubmed]
PHST- 1998/08/06 00:01 [medline]
PHST- 1998/08/06 00:00 [entrez]
PST - ppublish
SO  - Masui. 1998 Jun;47(6):720-5.