Anesthetic management for brain-dead lung transplant for Osler's disease complicated with polycythemia

Abstract

　We encountered a case of anesthesia of a brain-dead lung transplant for Osler's disease associated with marked polycythemia. We report a case of a 15-year-old man exhibiting polycythemia, with a hemoglobin (Hb) count of 26 g/dL and hematocrit (Ht) of 78%, which was revealed by a preoperative examination. The Ht value should be lowered to perform cardiopulmonary bypass (CPB). Therefore, crystalloid loading was performed before CPB, and blood preservation under CPB was added. In addition, the blood pressure waveform of the radial artery was overdamped from the time of anesthesia induction, and INVOS^® did not display a numerical value. However, when the Ht value decreased, radial artery waveform and INVOS became normalized. It is possible that these monitors were improperly used for treating advanced polycythemia.