[A case of severe hypotension with catecholamine-resistant septic shock in the perioperative period]

We report general anesthesia of a 79-year-old man complicated with septic shock from abdominal artery graft infection. When he entered the operating room, intravenous dopamine, dobutamine, and noradrenaline had been administered and his bood pressure was 50/32 mmHg. General anesthesia was induced with inhalation of oxygen-sevoflurane and rocuronium, and maintained with sevoflurane-oxygen. During the operation, the patient's blood pressure was 40-50/30-35 mmHg, and heart rate decreased gradually to 50 beats x min(-1). Although various vasopressors (dopamine, dobutamine, noradrenaline, adrenaline, ephedrine, phenylephrine, atropine and vasopressin) were administered, they were not effective to improve severe hypotension. After the operation, we started blood purification (PMX-DHP+CHDF), and in consequence blood pressure increased. It was thought that hemodynamics improved remarkably by reducing humoral mediators. In conclusion, it is considered that patients with septic shock should undergo immediate diagnosis and the source control should be performed in the minimum period, because it is possible that any vasopressor become ineffective when hypercytokinemia developes.