CASE REPORT   

Chirurgia 2020 June;33(3):164-6

DOI: 10.23736/S0394-9508.19.04989-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Takotsubo Syndrome following low-dose esmolol as treatment for epinephrine-induced tachycardia during endoscopic sinus surgery

Yeo-Jung KIM, Sang-Min LEE, Seok-Hwa YOON, Yong-Sup SHIN, Chae-Seong LIM ✉

Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea

Epinephrine is often injected locally for endoscopic sinus surgery. However, epinephrine can cause pulmonary edema and Takotsubo syndrome, and may even lead to cardiac arrest. This case report describes a 51-year-old woman with an excessive response to epinephrine administered while the anesthesiologist was temporarily absent. Severe tachycardia and hypertension developed. The depth of anesthesia was increased and esmolol (10 mg) was administered twice with a neuromuscular blocker. After 10 minutes, systolic blood pressure dropped to 42 mmHg and did not respond to phenylephrine. Transthoracic echocardiography showed a pattern typical of Takotsubo syndrome, and the patient required intensive care for 2 days.

KEY WORDS: Takotsubo cardiomyopathy; Esmolol; Epinephrine