Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery

Annals of Cardiac Anaesthesia
Feyzi ArtukogluThomas M Hemmerling

Abstract

We present a case of stress-induced myocardial stunning, also known as Tako-Tsubo syndrome, in an anaesthetised patient undergoing arthroscopic replacement of the cruciate ligament. The patient's (44 y male, ASA class II) had a history of hypertension with no other known disease. He underwent a femoral nerve block with 20 ml of 0.5% ropivacaine before receiving a balanced general anaesthesia (propofol induction, sevoflurane maintenance, 10 microg/kg sufentanil). Ten min after the beginning of surgery during endoscopic intra-articular manipulation, the patient suffered from bradycardia and hypotension; following the administration of ephedrine and atropine, he developed tachycardia, hypertension and ST segment depression. Subsequently, his systemic blood pressure dropped necessitating inotropic drug support and--later--intraaortic balloon counterpulsation; a TEE revealed no evidence of hypovolemia, anterior and antero-septal hypokinesia with an ejection fraction of 25%. Surgery was finished whilst stabilising the patient haemodynamically. Postoperative cardiac enzymes showed little elevation, an emergency coronary angiogram apical akinesia with typical ballooning and basal hyperkinesias, compatible with Tako-Tsubo syndrome. The ...Continue Reading

References

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Citations

Sep 3, 2013·Annales Françaises D'anesthèsie Et De Rèanimation·E BesnierB Dureuil
Jun 26, 2013·Revista española de anestesiología y reanimación·H D de Boer, L H D J Booij
Feb 17, 2009·International Journal of Cardiology·Misbahuddin MohammadSamuel J Asirvatham
Oct 3, 2008·Annales Françaises D'anesthèsie Et De Rèanimation·J CabatonV Piriou
Dec 30, 2014·International Journal of Surgery Case Reports·Niels HammerDirk Winkler
Jun 22, 2016·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Eugene A Hessel
Sep 19, 2008·Journal of Cardiovascular Medicine·Emanuele Catena, Donato Mele
Jul 12, 2017·Case Reports in Anesthesiology·Emmanuel LilitsisCharalampos Mamoulakis
Nov 4, 2017·Seminars in Cardiothoracic and Vascular Anesthesia·Shvetank AgarwalManuel R Castresana

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