[Perioperative management for acute abdominal aortic obstruction in a patient with acute myocardial reinfarction associated with acute renal failure].

A 73-year-old man presented with pain in lower limbs, lower abdomen, and anterior chest. His past medical history includes inferior myocardial infarction 3 years ago and hypertension. Electrocardiogram revealed ST elevation in II, III, and aVF indicating inferior myocardial reinfarction and angiography showed abdominal aortic embolism. Axillobifemoral bypass was performed urgently under general anesthesia. Because the patient developed acute renal failure and furosemide did not show diuretic effect, hemodialysis was used. The patient needed circulatory support with dopamine, dobutamine, epinephrine, and lidocaine intraoperatively. Approximately 90 minutes after the start of the operation, the patient developed ventricular fibrillation. The cardiac rhythm returned to normal after 2 minutes of cardiopulmonary resuscitation. The operation was performed successfully. An increase in serum potassium and metabolic acidosis were not noted postoperatively. However, weaning from the catecolamines was very difficult, and the patient died on 29th postoperative day. In this case, we employed general anesthesia without epidural anesthesia, because intraoperative hypotension might be the major cause for perioperative cardiac complications. Increase in serum potassium and myoglobin and metabolic acidosis were reported to occur after revascularization. Because the patient developed acute renal failure, intraoperative hemodialysis was valuable for preventing adverse effects due to reperfusion.