[Anesthetic management using the arterial pressure-based cardiac output monitor and a central venous oximetry catheter for tricuspid valve replacement in a patient receiving hemodialysis].

A 64-year-old man receiving hemodialysis underwent a tricuspid valve replacement. We used an arterial pressure-based cardiac output (APCO) monitor and a central venous oximetry catheter instead of pulmonary artery catheter because the enlargement of the right ventricle caused by tricuspid valve regurgitation might make it difficult to insert the pulmonary artery catheter. Aortic calcification was so severe that an arterial cannula was sewn into the right subclavian artery. Therefore, we had to insert an arterial catheter into the shunt placed on his left upper limb, and connected it to the APCO monitor FloTrac (Edwards Life-sciences, U.S.A.). Anesthesia was induced with intravenous fentanyl, midazolam and rocuronium, and maintained with fentanyl and propofol. A triple lumen PreSep central venous oximetry catheter (Edwards Lifesciences, USA) was inserted via his right internal jugular vein. Under cardiopulmonary bypass beating tricuspid valve replacement was performed. Although a large amount of catecholamine was needed for weaning from cardiopulmonary bypass, it was performed referring to the cardiac index of APCO monitor. The operation was finished successfully. We concluded that cardiac function should be evaluated with the relative change of cardiac index from APCO monitor when the absolute value was uncertain from patient's pathology (e.g., valvular disease).