[Perioperative management of a patient with polycythemia who developed massive hemorrhage]

A 34-year-old man, 170 cm in height and 70 kg in weight, was scheduled for emergency operation because of gastric perforation due to gastric cancer under general anesthesia. His preoperative blood analysis showed 5.2 x 10(3) mm(-3) of red blood cell, 18 g x dl(-1) of hemoglobin and 48% of hematocrit. Based on this and other data, he was diagnosed as having polycythemia caused by stress. Anesthesia was induced with thiopental and maintained with O2-N2O-sevoflurane. The intraoperative blood loss reached approximately 7,000 ml. Although we administered only 4 units of fresh-frozen plasma (FFP) and 9,150 ml of fluid with no red cell concentrated, his hemodynamic state was stable during surgery. After the surgery, we administered the minimum amount of FFP according to his blood analysis. Although red cell concentrated was not administered in the perioperative period, his general condition remained stable.