{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:57:54Z","timestamp":1765886274730},"reference-count":11,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>This case report describes the prolonged general anesthetic management of a 41-year-old woman with antiphospholipid syndrome (APS), systemic lupus erythematosus, and previously undiagnosed decreased cardiac function who underwent planned partial resection of the left tongue, tracheostomy, neck dissection, and pedicled flap reconstruction. This was immediately followed by emergent surgery to salvage the flap, and 1 month later, revision of the soft tissue flap was performed. A preoperative echocardiogram was performed because of her various risk factors, which identified lateral wall hypokinesis and reduced left ventricular ejection fraction of 40%, despite no known cardiovascular disease. However, cardiology consult determined no additional treatment was needed before the surgery. Multiple antithrombotic strategies were used, including elastic stockings, intermittent pneumatic compression devises, and heparin bridging. During the general anesthetic, stroke volume variation (SVV) was used to assess cardiac function and guide fluid management. There were no signs of systemic thrombosis, although the free flap reconstruction was abandoned because of a thrombus in the vascular anastomosis. Cardiac function can deteriorate in APS patients because of coronary and\/or microvascular thrombosis. Therefore, it is necessary to evaluate cardiac function, regardless of a known history of cardiovascular disease. Moreover, additional monitoring (ie, SVV) may be useful during prolonged general anesthetics for patients with APS and cardiac dysfunction.<\/jats:p>","DOI":"10.2344\/anpr-67-03-07","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:13:51Z","timestamp":1617840831000},"page":"33-37","source":"Crossref","is-referenced-by-count":1,"title":["Cardiovascular Considerations in Anesthetic Management for a Patient With Antiphospholipid Syndrome and Decreased Cardiac Function: A Case Study"],"prefix":"10.2344","volume":"68","author":[{"given":"Makiko","family":"Shibuya","sequence":"first","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukifumi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shigeru","family":"Takuma","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nobuhito","family":"Kamekura","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiaki","family":"Fujisawa","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1191","reference":[{"key":"i0003-3006-68-1-33-b01","series-title":"Arthritis Rheum.","first-page":"1019","article-title":"Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients","volume":"46","author":"Cervera","year":"2002","unstructured":"Cervera\n              R,\n            \n            \n              Piette\n              JC,\n            \n            \n              Font\n              J,\n            \n            et al.\n\t\t\t\t\t\n          Antiphospholipid syndrome: clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients.\n\t\t\t\t\tArthritis Rheum.2002;\n\t\t\t\t\t46:\n\t\t\t\t\t1019\u2013\n\t\t\t\t\t1027."},{"key":"i0003-3006-68-1-33-b02","series-title":"Br J Haematol.","first-page":"447","article-title":"Risk of arterial thrombosis in patients with anticardiolipin antibodies and lupus anticoagulant","volume":"96","author":"Nojima","year":"1997","unstructured":"Nojima\n              J,\n            \n            \n              Suehisa\n              E,\n            \n            \n              Akita\n              N,\n            \n            et al.\n\t\t\t\t\t\n          Risk of arterial thrombosis in patients with anticardiolipin antibodies and lupus anticoagulant.\n\t\t\t\t\tBr J Haematol.1997;\n\t\t\t\t\t96:\n\t\t\t\t\t447\u2013\n\t\t\t\t\t450."},{"key":"i0003-3006-68-1-33-b03","series-title":"Masui","first-page":"1298","article-title":"Prophylaxis of perioperative pulmonary thromboembolism in a patient with anti-phospholipid antigen syndrome","volume":"54","author":"Ebina","year":"2005","unstructured":"Ebina\n              Y,\n            \n            \n              Kishi\n              Y,\n            \n            \n              Baba\n              M,\n            \n            et al.\n\t\t\t\t\t\n          Prophylaxis of perioperative pulmonary thromboembolism in a patient with anti-phospholipid antigen syndrome.\n\t\t\t\t\tMasui.\n\t\t\t\t\t2005;\n\t\t\t\t\t54:\n\t\t\t\t\t1298\u2013\n\t\t\t\t\t1301."},{"key":"i0003-3006-68-1-33-b04","series-title":"Ann Intern Med.","first-page":"974","article-title":"Myocardial infarction caused by cardiac microvasculopathy in a patient with the primary antiphospholipid syndrome","volume":"116","author":"Kattwinkel","year":"1992","unstructured":"Kattwinkel\n              N,\n            \n            \n              Villanueva\n              AG,\n            \n            \n              Labib\n              SB,\n            \n            et al.\n\t\t\t\t\t\n          Myocardial infarction caused by cardiac microvasculopathy in a patient with the primary antiphospholipid syndrome.\n\t\t\t\t\tAnn Intern Med.1992;\n\t\t\t\t\t116:\n\t\t\t\t\t974\u2013\n\t\t\t\t\t976."},{"key":"i0003-3006-68-1-33-b05","series-title":"Arch Cardiovasc Dis.","first-page":"461","article-title":"Coronary microvasculopathy and intracardiac thrombosis in antiphospholipid syndrome","volume":"105","author":"Onea","year":"2012","unstructured":"Onea\n              R,\n            \n            \n              Germain\n              P,\n            \n            \n              Zimmermann\n              A.\n            \n          \n          Coronary microvasculopathy and intracardiac thrombosis in antiphospholipid syndrome.\n\t\t\t\t\tArch Cardiovasc Dis.2012;\n\t\t\t\t\t105:\n\t\t\t\t\t461\u2013\n\t\t\t\t\t462."},{"key":"i0003-3006-68-1-33-b06","series-title":"Arthritis Rheum.","first-page":"2093","article-title":"Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: a controlled cardiac magnetic resonance imaging study","volume":"62","author":"Sacre","year":"2010","unstructured":"Sacre\n              K,\n            \n            \n              Brihaye\n              B,\n            \n            \n              Hyafil\n              F,\n            \n            et al.\n\t\t\t\t\t\n          Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: a controlled cardiac magnetic resonance imaging study.\n\t\t\t\t\tArthritis Rheum.2010;\n\t\t\t\t\t62:\n\t\t\t\t\t2093\u2013\n\t\t\t\t\t2100."},{"key":"i0003-3006-68-1-33-b07","series-title":"Ther Res.","first-page":"743","article-title":"Advances in antiphospholipid antibody research","volume":"34","author":"Atsumi","year":"2013","unstructured":"Atsumi\n              T.\n            \n          \n          Advances in antiphospholipid antibody research.\n\t\t\t\t\tTher Res.2013;\n\t\t\t\t\t34:\n\t\t\t\t\t743\u2013\n\t\t\t\t\t747."},{"key":"i0003-3006-68-1-33-b08","series-title":"Medicine (Baltimore)","first-page":"195","article-title":"Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients","volume":"77","author":"Asherson","year":"1998","unstructured":"Asherson\n              RA,\n            \n            \n              Cervera\n              R,\n            \n            \n              Piette\n              JC,\n            \n            et al.\n\t\t\t\t\t\n          Catastrophic antiphospholipid syndrome. Clinical and laboratory features of 50 patients.\n\t\t\t\t\tMedicine (Baltimore).\n\t\t\t\t\t1998;\n\t\t\t\t\t77:\n\t\t\t\t\t195\u2013\n\t\t\t\t\t207."},{"key":"i0003-3006-68-1-33-b09","series-title":"J Rheumatol","first-page":"508","article-title":"The catastrophic antiphospholipid syndrome","volume":"19","author":"Asherson","year":"1992","unstructured":"Asherson\n              RA.\n            \n          \n          The catastrophic antiphospholipid syndrome.\n\t\t\t\t\tJ Rheumatol.\n\t\t\t\t\t1992;\n\t\t\t\t\t19:\n\t\t\t\t\t508\u2013\n\t\t\t\t\t512."},{"key":"i0003-3006-68-1-33-b10","series-title":"J Cardiothorac Surg.","first-page":"101","article-title":"Antiphospholipid syndrome; its implication in cardiovascular diseases: a review","volume":"5","author":"Koniari","year":"2010","unstructured":"Koniari\n              I,\n            \n            \n              Siminelakis\n              SN,\n            \n            \n              Baikoussis\n              NG,\n            \n            \n              Papadopoulos\n              G,\n            \n            \n              Goudevenos\n              J,\n            \n            \n              Apostolakis\n              E.\n            \n          \n          Antiphospholipid syndrome; its implication in cardiovascular diseases: a review.\n\t\t\t\t\tJ Cardiothorac Surg.2010;\n\t\t\t\t\t5:\n\t\t\t\t\t101."},{"key":"i0003-3006-68-1-33-b11","series-title":"Autoimmun Rev.","first-page":"174","article-title":"Lessons from the \u201cEuro-Phospholipid\u201d project","volume":"7","author":"Cervera","year":"2008","unstructured":"Cervera\n              R.\n            \n          \n          Lessons from the \u201cEuro-Phospholipid\u201d project.\n\t\t\t\t\tAutoimmun Rev.2008;\n\t\t\t\t\t7:\n\t\t\t\t\t174\u2013\n\t\t\t\t\t178."}],"container-title":["Anesthesia Progress"],"original-title":[],"link":[{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/68\/1\/article-p33.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/anesthesia-progress\/article-pdf\/68\/1\/33\/2840439\/i0003-3006-68-1-33.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/68\/1\/article-p33.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/downloadpdf\/journals\/anpr\/68\/1\/article-p33.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T12:44:51Z","timestamp":1728305091000},"score":1,"resource":{"primary":{"URL":"https:\/\/anesthesiaprogress.kglmeridian.com\/view\/journals\/anpr\/68\/1\/article-p33.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021]]},"references-count":11,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.2344\/anpr-67-03-07","relation":{},"ISSN":["1878-7177","0003-3006"],"issn-type":[{"type":"electronic","value":"1878-7177"},{"type":"print","value":"0003-3006"}],"subject":[],"published":{"date-parts":[[2021]]}}}