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[Postoperative pancreatitis after total hip replacement under general anesthesia].
K Kabutan1, M Mishima, S Takehisa
1Department of Anesthesiology, National Okayama Hospital.
Masui. the Japanese Journal of Anesthesiology
|April 7, 2000
Summary
Postoperative pancreatitis occurred in a patient after hip replacement. Circulatory disturbance of the pancreas due to intraoperative hypotension is suspected as the cause.
Area of Science:
- Anesthesiology
- Nephrology
- Gastroenterology
Background:
- A 61-year-old male with chronic renal failure on hemodialysis underwent total hip replacement under sevoflurane anesthesia.
- Significant intraoperative blood loss (1500 ml) and transfusion (1200 ml) occurred.
- Intraoperative mean blood pressure was maintained between 60-70 mmHg, with a final central venous pressure of 0 mmHg.
Observation:
- The patient developed severe upper abdominal pain postoperatively.
- Serum amylase levels elevated significantly (15x normal) on postoperative day 1.
- Abdominal pain recurred during hemodialysis sessions.
Findings:
- The clinical presentation suggests postoperative pancreatitis.
- The patient's history of chronic renal failure and hemodialysis may be relevant factors.
- Intraoperative hemodynamic instability, specifically hypotension and low central venous pressure, is hypothesized to have caused pancreatic circulatory disturbance.
Implications:
- This case highlights a potential link between intraoperative hypotension and postoperative pancreatitis in patients with renal failure.
- Careful hemodynamic management is crucial in high-risk surgical patients.
- Further research is warranted to elucidate the mechanisms of pancreatic injury in this context.