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[Anesthetic management of a patient with acute idiopathic pandysautonomia].

Acute idiopathic pandysautonomia (AIPD) is a very rare disease with acute onset of impairment in the peripheral sympathetic and parasympathetic nerves. We report the anesthetic management of a patient with AIPD undergoing bladder lithotomy and scrotum abscess drainage. A 64-year-old man had a severe orthostatic hypotension, and was extremely sensitive to intravenous norepinephrine because of denervation hypersensitivity. Before the surgery, the patient was sufficiently hydrated. We planned to administer a vasopressor (phenylephrine) and a vasodilator (nicardipine) at 1/10 of usual doses. After placement of a radial artery catheter, combined epidural and spinal anesthesia was performed with the patient in a right lateral position. Blood pressure decreased slightly after placing him in a supine position. However, no medication was needed, and the patient showed no perioperative complications.