• Rie Yazawa, Tatsuya Kondo, Tetsuya Miyashita, Yasuhiro Koide, Tomio Andoh, and Yoshitsugu Yamada.
• Department of Anesthesiology, Yokohama City University School of Medicine, Yokohama 236-0004.
• Masui. 2004 Jan 1; 53 (1): 55-8.

AbstractA 65-year-old woman with olivopontocerebellar atrophy (OPCA), manifested with cerebellar ataxia mainly, with coexisting impairment of the autonomic nervous system function, and extrapyramidal symptoms, was scheduled for cholecystectomy. With no premedication, anesthesia was induced with sevoflurane and maintained with 1-1.5% of sevoflurane and 66% of nitrous oxide mixed with oxygen. Heart rate variability (HRV) calculated from ECG was used for a monitor of the autonomic nervous system activity. Before the induction of anesthesia, severe reduction of the HRV parameters suggested that both her sympathetic and parasympathetic nervous activities might have been severely reduced. We considered that the patient might have postganglionic sympathetic nerve hypersensitivity against inotropic agents. When her blood pressure decreased temporarily after the induction of anesthesia, a bolus dose of ephedrine 1 mg wa given intravenously, which stimulated the sympathetic nervous system indirectly, and could increase her blood pressure. Hypotension during anesthesia in a patient with OPCA with severe autonomic nervous failure was successfully treated by a minimal dose of ephedrine.

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