Spinal and General Anesthesia in a Patient with Shy-Drager Syndrome

Shy-Drager syndrome is a primary degenerative disease of the sympathetic nervous system that is characterized by orthostatic hypotension. Failure of autonomic cardiovascular responses during anesthesia and surgery make anesthetic management difficult. Careful anesthetic management, along with choosing an appropriate anesthetic method and vasopressor, is important. The present paper reports the spinal and general anesthetic course of a patient with Shy-Drager syndrome who underwent surgery twice (bladder and tounge). Preanesthetic evaluation revealed that pressure response to epinephrine was exaggerated. During spinal anesthesia systemic blood pressure decreased by 30mmHg after intrathecal injection of the local anesthetic agent at a level of Th10, and this condition was treated with fluid infusion and etilepfrine. The blood pressure response seemed normal. General anesthesia was maintained with nitrous oxide and isoflurane. Blood pressure remained very stable with continuous dopamine infusion.