Pulsus alternans in a dialysis patient with dilative cardiomyopathy during intra-operative anesthesia

Abstract

We present a case on continuous ambulatory peritoneal dialysis (CAPD) who developed pulsus alternans during abdominal surgery.
A 13-year-old female with dilative cardiomyopathy on CAPD underwent partial omentectomy and implantation of a CAPD catheter under general anesthesia (midazolam, pentazocin, nitrous oxide). Pulsus alternans appeared at the start of intra-abdominal procedures, but the surgery was carried out uneventfully under close observation of hemodynamic condition by echocardiographic monitoring. Pulsus alternans persisted throughout the operation, but suddenly disappeared soon after the nitrous oxide gas was turned off at the end of anesthesia.
Pulsus alternans is generally considered a sign of severe left ventricular dysfunction, usually secondary to dilative cardiomyopathy and aortic stenosis. This patient, however, was not in the state of severe hurt failure and did not have any valvular disease. Although dilative cardiomyopathy might have been an indirect cause of the pulsus alternans seen in this patient, it was suspected that the occurrence of this pulsus alternans was related to the intra-abdominal procedures and general anesthesia, judging from its appearance and attenuation.