Cardiovascular collapse during anesthesia in a patient with preoperatively discontinued chronic MAO inhibitor therapy

Journal of Clinical Anesthesia
J SprungI C Lavery

Abstract

We describe a patient in whom long-term monoamine oxidase (MAO) inhibitor therapy was discontinued 20 days before surgery with general anesthesia. This patient developed severe perioperative hypotension after administration of 10 mg of bupivacaine through an epidural catheter, which was corrected only after potent vasopressor therapy. We attribute this hemodynamic instability to attenuation of this patient's sympathetic tone based on several mechanisms: (1) residual effect of long-term administration of MAO inhibitor that caused a decrease in the number of beta-adrenergic receptors (adrenergic subsensitivity due to receptor down-regulation), (2) recovered MAO activity causing effective degradation of sympathetic amines, and (3) combined attenuating effects of general and epidural anesthesia on sympathetic tone.

References

Jan 1, 1989·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·D G Wells, A R Bjorksten
Feb 1, 1988·British Journal of Anaesthesia·C G StackS P Linter
Jan 1, 1985·Psychopharmacology·R J RossW Z Potter
Dec 1, 1994·Human Molecular Genetics·H Mochizuki, M Prochazka
Mar 1, 1993·Cleveland Clinic Journal of Medicine·Z Y EbrahimJ Tetzlaff

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Citations

Jan 21, 2009·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Louise R A Olde NordkampNynke van Dijk
Jan 15, 2009·Revista brasileira de psiquiatria : orgão oficial da Associação Brasileira de Psiquiatria, Asociación Psiquiátrica de la América Latina·Rafael Bernardon RibeiroSérgio Paulo Rigonatti

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