ANESTHETIC MANAGEMENT OF A PATIENT WITH BARTTERS-SYNDROME

Bartter's syndrome is a rare disorder characterized by normal or low a rterial blood pressure (BP), despite marked elevation in plasma renin activity, angiotensin II (Ang-II), and aldosterone, along with hypokal emic metabolic alkalosis. Perioperative changes in the cardiovascular and renin-angiotensin-aldosterone (RAA) systems in Bartter's syndrome patients are not well understood. We managed a 44-year-old Japanese ma n with rectal cancer and Bartter's syndrome complicated by renal dysfu nction. He underwent anterior resection of the rectum with general ane sthesia (50% nitrous oxide-oxygen with 0.5% to 0.8% isoflurane, supple mented with intravenous midazolam and butorphanol). Epidural morphine was given postoperatively. Although BP tended to be lower (75/35 to 11 0/60 mmHg) during surgery, there were no profound perioperative hemody namic derangements. Plasma renin activity, Ang-II, and aldosterone val ues were highest during surgery. These responses of the RAA system to anesthesia and surgery were the same as previously noted in otherwise healthy surgical patients.