Abstract
To consider measures to be taken for emergency operations on hemodialysis patients, 20 patients on whom abdominal surgery was recently performed (12 elective operations and 8 emergency operations) were selected mainly to study changes in the circulation by using a Swan-Ganz catheter. In the case of elective operation, the cardiac index (CI) was reduced to the normal lower limit before the operation, but soon improved to show no change in the pulmonary arterial diastolic pressure (PADP) thereafter, maintaining a stable condition of cardiac function.
In the case of emergency operation, on the other hand, insufficient removal of water and the critical cause of the disease had increased PADP before the operation, but it recovered to normal after the operation, which was performed after the removal of the cause by an operation. After the operation, both CI and PADP were increased, showing a tendency toward an increase in cardial load. As to the water balance during the operation, the fluid balance during elective operation was 3ml/kg/hr, while it was increased to 4.6ml/kg/hr during emergency operation. Dialysis was performed 14.6±3.2hr. after emergency operation, significantly earlier than the 29.3±12.6hr. after elective operation.
From the above findings the, in the case of emergency operation, the following points should be taken into account: 1. Perform emergency dialysis as much as possible before the operation. 2. Provide a circulation monitor and set the fluid volume according to the monitor. 3. Remove the cause of the disease as early as possible by an operation. 4. Perform dialysis as early as possible after the operation. Emergency operations on dialysis patients should be performed with the above points kept in mind.
