[Anesthetic management of adrenalectomy in a patient with aldosteronism complicated with hypertrophic cardiomyopathy].

We had a rare patient for adrenalectomy who had aldosteronism complicated with hypertrophic cardiomyopathy (HCM). It has been suggested that aldosteronism could be the cause of HCM. The association is not clear in this case, but there is a possibility that myocardial hypertrophy was deteriorated with hypertension caused by aldosteronism. Two important points of the anesthetic management of a patient with HCM are (1) to prevent direct or reflex increases in contractility, and (2) to maintain adequate preload and afterload. In a case complicated with aldosteronism, there is a risk that a significant increase in peripheral vascular resistance following the manipulation of the adrenal gland would aggravate left ventricular pressure load, resulting in a marked decrease in cardiac output. Therefore, in such a case, vasodilators which are said to be poorly tolerated in a patient with HCM might be considered to facilitate the anesthetic management, provided that the vascular system is kept appropriately full. In this case, we employed enflurane-oxygen-nitrous oxide with fentanyl to keep deep levels of general anesthesia. Nitroglycerin (NTG) was used when arterial pressure increased suddenly with the manipulation of the adrenal gland. The effect of NTG is not definitely convincing since blood pressure returned to normal after adrenal excision. But the fact that pulmonary capillary wedge pressure decreased with infusion of NTG suggests improvement of hemodynamic function.