[Management of epidural anesthesia in a patient with aortitis syndrome]

We report an anesthetic management of a patient with severe vascular occlusion case caused by Aortitis syndrome. The patient, 61 yr-old woman, was scheduled for sigmoidectomy. Her bilateral common carotid arteries and left main coronary artery were totally occluded, but she had been asymptomatic for over thirty years. Epidural anesthesia was chosen to provide pain control, cardiovascular stability, and also to maintain consciousness during operation for cerebral circulatory evaluation. Following intravenous administration of lactated Ringer's solution (about 1000 ml), epidural blockade was maintained with 1 to approximately 1.5% lidocaine and butorphanol. Our findings in this case indicate that it is important for coronary and cerebral perfusion to have normal central venous pressure (preload) and arterial pressure during sympathetic blockade resulting from epidural anesthesia.