주술기 Sildenafil과 흡입용 Iloprost 병용처치를 통한 중등도 문맥 폐동맥 고혈압 환자의 간이식 마취 경험 -증례보고- (Perioperative Combined Use of Sildenafil and Inhaled Iloprost for Moderate Portopulmonary Hypertension in a Patient Undergoing Liver Transplantation -A case report-)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Korean Journal of Anesthesiology / 54권 / 1호 / 102 ~ 108페이지
· 저자명 : 김덕경, 김혜경, 임정애, 정승민, 장성환, 윤익진

초록

Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) ＞ 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyneㆍsecㆍcm−5 preoperatively. He was treated with oral sildenafil (ViagraⓇ) and inhaled iloprost (VentavisⓇ) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyneㆍsecㆍcm−5 at the time of transplantation. During OLT, his mPAP was stable of 28−38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days.

영어초록

Moderate to severe pulmonary hypertension, mean pulmonary arterial pressure (mPAP) ＞ 35 mmHg, in cirrhotic patients is usually considered an absolute contraindication to orthotopic liver transplantation (OLT) because of unacceptably high mortality. We present the case of successful OLT in a cirrhotic patient with a mPAP of 42 mmHg and a pulmonary vascular resistance (PVR) of 298 dyneㆍsecㆍcm−5 preoperatively. He was treated with oral sildenafil (ViagraⓇ) and inhaled iloprost (VentavisⓇ) for 45 days and then his mPAP and PVR were reduced to 33 mmHg and 206 dyneㆍsecㆍcm−5 at the time of transplantation. During OLT, his mPAP was stable of 28−38 mmHg with the combined use of sildenafil via a nasogastric tube and iloprost via a nebulizer. His hemodynamic parameters were stable and significant postoperative bleeding was not noticed throughout his stay in the intensive care unit. Thereafter, he was transferred to general ward without any cardio-respiratory problems on 7th postoperative days.

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