[Intraoperative ST-T depression during extreme hemodilution].

ABSTRACT

A 45 year old woman undergoing a removal of cerebral arterio-venous malformation, suffered an unexpected massive bleeding. With transfusion of plasma constituents, her hemoglobin concentration decreased to about 5 g.dl-1, but her hemodynamic parameters remained unchanged. Electrocardiogram showed a depressed ST segment, indicating myocardial ischemia, when hemoglobin concentration decreased to 2.2 g.dl-1. Accompanied with the ECG change, her blood pressure fell down from 110/70 mmHg to 70/40 mmHg and an elevation of CVP was observed. With rapid transfusion of concentrated red cell and whole blood, hemodynamic parameters as well as ECG change were restored to normal. With hemodilutional myocardial ischemia which is caused by acute massive bleeding, hemoglobin concentration of about 2 g.dl-1 would be critical.