We report one case of anesthetic management of a patient with tuberous sclerosis undergoing renal transplantation.
Case reportA 36-year-old woman (160 cm, 56 kg) with tuberous sclerosis, diagnosed 6 years previously, was scheduled for living-donor renal transplantation. The patient had suffered from chronic renal failure for 6 years; the renal parenchyma was replaced by bilateral angiomyolipomas. Four years previously, she underwent unilateral (left) nephrectomy because of massive hematuria and uncontrolled bleeding, but she did not require dialysis. Her blood urea nitrogen was 30 mg·dl Ϫ1 (21 mmol·l Ϫ1 ) and her serum creatinine was 5.4 mg·dl Ϫ1 (480 µmol·l Ϫ1 ).Three times during the past 15 years she had had spontaneous pneumothorax; the last time (10 years previously) she underwent right pleurodesis. After both surgical operations, she was admitted to the intensive care unit (ICU) for routine postoperative management. Her recovery after the nephrectomy was uneventful, and she returned to the ward on the second postoperative day. After the pleurodesis, her stay in the ICU was prolonged to 2 weeks because of a pulmonary infection.She suffered from petit mal seizures between the ages of 3 and 6 years but had no mental retardation. She was a regular smoker (10 packet-years). She was not under regular medical treatment and had no history of drug allergy. The nephrologists suggested that she should have one session of hemodialysis 12 h before operation. Preoperative physical examination disclosed facial angiofibroma over the cheeks and nose and subungual fibromas and shagreen patch (leathery thickening patch) over the lumbosacral region. Her muscle tone and reflexes in all limbs were normal. Physical examination of the respiratory and cardiovascular system was
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