[Anesthetic management of a hemodialysis-dependent patient implanted with a CRT-D device undergoing an operation for perforated peritonitis].

A 53-year-old man was admitted to our hospital for hematochezia, and an emergency operation was scheduled for his perforated sigmoid colon. He had received a CRT-D (cardiac resynchronization therapy with defibrillator) device for dilated cardiomyopathy two years before and had been receiving hemodialysis for the past year. Anesthesia was induced with midazolam and remifentanil and maintained with remifentanil and sevoflurane in oxygen. Before surgery, we disabled the defibrillation function of the CRT-D device and changed its pacing mode from VVI to VOO, and electrodes of an external defibrillator were attached to the chest wall. Dopamine and norepinephrine were administered via a central venous catheter, and systolic blood pressure was maintained between 70 and 80 mmHg and CVP between 8 and 13 mmHg. Sigmoidectomy was performed and he was transferred to the ICU intubated. Although intensive care procedures, such as mechanical ventilation, continuous hemodiafiltration, and direct hemoperfusion with polymyxin B-immobilized fibers were performed, he died of multiple organ failure on postoperative day 48. CRT-D has become mainstream cardiac resynchronization therapy and will require attention for anesthetic management of patients implanted with the CRT-D device.