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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
SOARES, Raquel Reis; ALBERGARIA, Viviane Ferreira; LORENTZ, Michelle Nacur and VALADARES, Friederike W.. Anesthesia for treatment of cardiac aspergillosis in a patient with thrombocytopenia and the judicious use of aprotinin. Rev. Bras. Anestesiol. [online]. 2007, vol.57, n.6, pp. 672-677. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942007000600010.
BACKGROUND AND OBJECTIVES: Aprotinin has been widely used in cardiac surgeries as a therapeutic resource for reducing the effects of cardiopulmonary bypass (CPB) on coagulation and fibrinolysis. Recovery of adequate hemostasia at the end of the procedure is one of the objectives of the anesthesiologist. However, aprotinin has specific indications. The objective of this report was to present the case of a patient with severe thrombocytopenia undergoing cardiac surgery in which consultation with Hematology and adequate planning were responsible for the success of the procedure. CASE REPORT: An 18-year old male patient, weighing 64 kg, physical status ASA IV, with a diagnosis of bone marrow aplasia, was being investigated to undergo bone marrow transplantation. He had persistent fever for a month, which did not improve with antibiotics. During the investigation with imaging exams, a left atrial mass was discovered. Laboratory exams revealed hemoglobin 9 g.dL-1 and thrombocytopenia with 6,000 platelets.mm3. He underwent a sternotomy with CPB to remove the intracavitary thrombus. In order to control intraoperative bleeding, the following was administered: plateletpheresis, hydrocortisone, and aprotinin. Increased bleeding and hemodynamic instability did not develop during the surgery, and the patient was transferred to the Intensive Care Unit (ICU) without intercurrences. The anatomo-pathologic exam revealed the thrombus to be filled with Aspergillus (fungal mass). On the seventh postoperative day the patient developed respiratory failure and cardiorespiratory arrest that did not respond to resuscitation maneuvers. CONCLUSIONS: Despite the increased risk of bleeding in this patient, cardiac surgery with CPB was performed without intercurrences due to the use of aprotinin and plateletpheresis.
Keywords : ANESTHESIA, Cardiac, general; DISEASES [aspergillosis, bone marrow aplasia, thrombocytopenia]; DRUGS [aprotinin]; SURGERY, Cardiac [cardiopulmonary bypass, left atrial mass].