[Fluid management after off-pump CABG in a patient receiving preoperative continuous ambulatory peritoneal dialysis]

Perioperative management of off-pump CABG in a patient receiving continuous ambulatory peritoneal dialysis (CAPD) was reported. Prior to the procedure, we considered that postoperative management could be performed by CAPD alone in the case of off-pump CABG. However, due to an unexpected increase in the circulating blood volume and dilution of blood after surgery, congestive cardiac failure developed and active dehydration was required for 3 days after the operation using CHDF and HD. Despite this treatment, the central venous pressure and the cardiothoracic ratio in the chest X-ray were elevated, and a state of volume overload continued. However, cardiac contractility was not disturbed as shown by echocardiography. A possible cause of this condition was that body fluid had accumulated in the third space such as the peritoneum and intestine due to long-term use of CAPD before surgery, and the fluid was mobilized after surgery.