We report the anesthetic management for emergency surgery of five patients with acute superior mesenteric artery occlusion. Although induction was performed with a combination of propofol, fentanyl and ketamine, their hemodynamics was relatively stable during the induction and maintenance of anesthesia. Immediately after embolectomy, reperfusion of the superior mesenteric artery led to sudden hypotension, requiring the administration of fluids and vasoactive agents in two of four patients. Unfortunately, two of the five patients died of cardiac arrest and multiple organ failure in the early postoperative period. While total intravenous anesthesia with propofol, fentanyl and ketamine may provide stable anesthetic management in patients with superior mesenteric artery occlusion, it must be emphasized that in addition to careful intraoperative management, such patients require intensive and multiple organ care during the postoperative period.
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