[Anesthetic Management for Laparoscopic Surgery in a Very Elderly Patient with Severe Mitral Regurgitation]

A 90-year-old woman with severe mitral regurgitation underwent laparoscopic cholecystectomy. In her anesthetic management, we used FloTrac system and monitored arterial pressure-based cardiac index (CI), stroke volume (SV), and stroke volume variation (SVV) continuously as the indicators of intraoperative hemodynamics. Although the blood pressure fluctuated highly in Fowler position especially, we could control hemodynamics appropriately by intermittent volume infusion and adjusting administration of cardiovascular agents under monitoring these indicators. In a very elderly patient with severe mitral regurgitation, anesthesia and operation may cause severe circulatory disturbances. Therefore, it is important to select proper monitoring as stated above and maintain hemodynamics with the utmost care and attention.