Intraoperative vascular anastomosis occlusion due to cold agglutinin disease during brain surgery: a case report.

IF 0.8 Q3 ANESTHESIOLOGY JA Clinical Reports Pub Date : 2025-01-18 DOI:10.1186/s40981-025-00766-z

Kazuma Kitamura, Mayumi Nakanishi, Naokazu Fukuoka, Kumiko Tanabe, Yoshinori Kamiya

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Abstract

Background: Cold agglutinin disease (CAD) is an autoimmune hemolytic anemia that induces blood coagulation and hemolysis upon exposure to cold temperatures. Strict temperature control is essential to mitigate these effects, especially during surgical procedures where hypothermia is possible.

Case presentation: A 57-year-old male, 165 cm and 72 kg, diagnosed with CAD, underwent cerebral vascular anastomosis. Intraoperatively, mean arterial pressure was maintained at or above 65 mmHg with phenylephrine administration, while body temperature was rigorously controlled between 36.5 °C and 37.5 °C using forced-air warming blankets and heated intravenous infusions. Despite these measures, thrombotic occlusion occurred, necessitating surgical thrombus removal, intravenous heparin administration, and irrigation of the surgical field with warmed saline followed by re-anastomosis. The anastomosis remained patent without recurrence of thrombus formation thereafter.

Conclusion: Preventing hypothermia is extremely important in the anesthesia management of CAD patients. However, careful attention must also be paid to temperature regulation in the surgical field.

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脑外科手术中冷凝素病致术中血管吻合口闭塞1例。

背景：冷凝集素病（CAD）是一种自身免疫性溶血性贫血，暴露在低温下诱导血液凝固和溶血。严格的温度控制对于减轻这些影响至关重要，特别是在可能发生低温的外科手术过程中。病例介绍：男性，57岁，身高165公分，体重72公斤，诊断为冠心病，行脑血管吻合术。术中给予苯肾上腺素使平均动脉压维持在或高于65 mmHg，同时采用强制空气加热毯和加热静脉输注将体温严格控制在36.5℃至37.5℃之间。尽管采取了这些措施，血栓闭塞还是发生了，需要手术清除血栓，静脉注射肝素，用温盐水冲洗手术野，然后再吻合。吻合口通畅，此后无血栓复发。结论：预防低温在冠心病患者的麻醉管理中至关重要。然而，也必须仔细注意手术领域的温度调节。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.