Blood management in a patient with anti-Oka antibody who underwent cardiac surgery using cardiopulmonary bypass: a case report.

BACKGROUND: Cardiac surgery under cardiopulmonary bypass (CPB) is often associated with massive bleeding and blood transfusion. For patients requiring specific blood products, meticulous blood management is critical to reduce blood loss, as well as the need for transfusion. Here, we have described the intraoperative blood management in a patient with anti-Oka antibody, who underwent cardiac surgery with CPB. CASE PRESENTATION: A 79-year-old woman was scheduled for open aortic valve replacement and tricuspid valve annuloplasty under hypothermic CPB. Her blood type was A RhD(+) Ok(a-), and anti-Oka, an extremely rare antibody against erythrocyte antigen, was detected. Eight units of Ok(a-) frozen thawed red cells (FTRCs), and six units of red blood cells donated by three Ok(a-) individuals were collected just prior to surgery. Although she was anemic, acute normovolemic hemodilution was conducted after anesthesia induction to preserve the autologous whole blood. Four units of FTRCs were loaded in the CPB priming solution, and modified ultrafiltration was adopted during CPB to prevent further hemodilution. After CPB termination, two units of FTRCs, four units of fresh frozen plasma, and ten units of platelet concentrate were intensively transfused, facilitating surgical hemostasis and stable hemodynamics. The autologous whole blood was returned to the patient in the intensive care unit. Since the hemoglobin and hematocrit levels were maintained postoperatively, no additional transfusion was required throughout her hospital stay. CONCLUSIONS: Multidisciplinary intraoperative blood management in a patient with anti-Oka antibody facilitated successful cardiac surgery using CPB, along with effective use of limited blood products.

[Anesthetic management for surgery of giant coronary aneurysms complicated with Churg-Strauss syndrome].

Few cases of Churg-Strauss syndrome (CSS) complicated by giant coronary aneurysms (CAs)have been reported thus far. We report a case of CSS in a 60-year-old man who underwent surgery for giant CAs, and was managed with anesthetics. The patient developed acute myocardial infarction, and was diagnosed with giant CAs in the right coronary artery (RCA, 11 cm) and circumflex artery (3 cm). The CA in RCA was communicating with the right ventricle. He had a history of pericardiectomy for pericarditis caused by the CSS and developed thrombocytopenia due to consumptive coagulopathy within the CAs. An operation, including ligation and excision of the CAs, and coronary artery bypass grafting was performed under general anesthesia and cardiopulmonary bypass. There was massive hemorrhage followed by hemodynamic instability while detaching the tight pericardial adhesion and fragile surface of the CAs. Massive transfusion was required along with inotropes administration and intraaortic balloon support. In this case, determination of the appropriate surgical timing was difficult because symptoms of the CSS became worse followed by rapid enlargement of the CAs, myocardial infarction, and thrombocytopenia. Steroids were administered for treating CSS, and the blood transfusion was sufficient. However, it was difficult to control the hemorrhage and maintain hemodynamic stability.

[Effects of carbon dioxide insufflation during endoscopic conduit harvesting in coronary artery bypass surgery].

BACKGROUND: Endoscopic vessel harvesting is becoming common for the patients undergoing coronary artery bypass grafting. Insufflation of carbon dioxide (CO2) during the procedures has been reported elsewhere to affect arterial carbon dioxide tension, but the occurrence of hypercapnia is still controversial. METHODS: We investigated the effects of CO2 insufflation during endoscopic harvesting of the saphenous vein (SV, n = 34), radial artery (RA, n = 14), or internal mammary artery (IMA, n = 7) for coronary artery bypass surgery. The conduit harvesting was performed using Vasoview Dissecting Cannula with insufflation of CO2 maintaining a cavity pressure of 8-10 mmHg. RESULTS: After insufflation of CO2, significant elevation of partial pressure of CO2 in arterial blood (PaCO2) was found during harvesting of SV (35.4 +/- 3.8 to 49.2 +/- 7.5 mmHg, P < 0.01) and of IMA (38.0 +/- 2.3 to 44.2 +/- 3.2 mmHg, P < 0.05), but no significant elevation of PaCO2 occurred during RA harvesting using a tourniquet. The extent of PaCO2 elevation in SV harvesting showed negative correlation with patient's body weight, body mass index, and body surface area. CONCLUSIONS: Significant hypercarbia occurs during endoscopic harvesting of SV or IMA. It is recommended that PaCO2 should be carefully monitored during endoscopic conduit harvesting for coronary artery bypass surgery.