Anesthetic experience of frontotemporal dementia patient with severe autonomic dysfunction: a case report

Abstract

Anesthetic experience in frontotemporal dementia (FTD) with severe hypotension associated autonomic dysfunction has not yet been reported. Here in case, we report on the case of treatment with vasopressin to refractory hypotension in FTD patient. A 54-year-old male presented with a ten-year history of FTD with frequent syncope. The patient was scheduled to undergo subtotal gastrectomy for resection of stomach cancer. During the operation, sudden hypotension occurred and it was refractory to fluid and 1 unit of blood resuscitation and did not respond to catecholamine. Transesophageal echocardiography showed normal heart with adequate volume state. After intravenous administration of arginine vasopressin, the patient's vital signs returned to baseline values. Arginine vasopressin might be considered as a valuable alternative for treatment of severe refractory hypotension in autonomic dysfunction patients with FTD.

Keywords: Autonomic nervous system disease; Frontotemporal dementia; Hypotension; Vasopressins.

Fig. 1. Timeline describing information from the case.

Fig. 2. MRI findings in frontotemporal dementia (FTD). T1 (A) and T2 (B) weighted MRI scan showed atrophy in the ventromedial frontal cortex, bilateral posterior orbital frontal regions, bilateral insula, anterior cingulate cortex, dorsolateral frontal cortex and premotor cortex to support FTD.