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. 2023 Feb 20;9(1):10.
doi: 10.1186/s40981-023-00601-3.

Anesthetic management of a patient with methamphetamine-associated pulmonary arterial hypertension undergoing laparoscopic cholecystectomy

Kensuke Oshita  1 , Shin Tokuyama  2 , Shosaburo Jotaki  2 , Michiko Yokomizo  2 , Teruyuki Hiraki  2
Affiliations

Anesthetic management of a patient with methamphetamine-associated pulmonary arterial hypertension undergoing laparoscopic cholecystectomy

Kensuke Oshita et al. JA Clin Rep. .

Abstract

Background: Methamphetamine abuse is a serious public health concern and causes various life-threatening disorders including pulmonary arterial hypertension (PAH). Herein, we present the first case report describing the anesthetic management of a patient with methamphetamine-associated PAH (M-A PAH) undergoing laparoscopic cholecystectomy.

Case presentation: A 34-year-old female with M-A PAH suffered from deterioration of right ventricular (RV) heart failure due to recurrent cholecystitis and was scheduled for laparoscopic cholecystectomy. Preoperative assessment of PA pressure showed 82/32 (mean, 50) mmHg, and transthoracic echocardiology revealed a slight reduction of RV function. General anesthesia was induced and maintained by thiopental, remifentanil, sevoflurane, and rocuronium. PA pressure gradually increased after peritoneal insufflation; therefore, we administered dobutamine and nitroglycerin to decrease pulmonary vascular resistance (PVR). The patient emerged from anesthesia smoothly.

Conclusions: Avoiding increased PVR by appropriate anesthesia and medical hemodynamic support is an important consideration for patients with M-A PAH.

Keywords: Methamphetamine; Peritoneal insufflation; Pulmonary arterial hypertension; Pulmonary artery catheter; Right ventricular dysfunction.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Anesthesia record. The ratio of mean pulmonary artery pressure to mean artery pressure (Pp/Ps) was increased from 0.36 to 0.58 after peritoneal insufflation, requiring an increase in the infusion rate of nitroglycerine. X: start and end of anesthesia; ◎: start and end of the operation. ABP, arterial blood pressure; HR, heart rate; PAP, pulmonary arterial pressure; Pp/Ps, the ratio of mean pulmonary artery pressure to mean artery pressure
See this image and copyright information in PMC

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