Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery
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 under...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2008-01-01
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| Series: | Annals of Cardiac Anaesthesia |
| Subjects: | |
| Online Access: | http://www.annals.in/article.asp?issn=0971-9784;year=2008;volume=11;issue=1;spage=38;epage=41;aulast=Artukoglu |
| _version_ | 1818983575928700928 |
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| author | Artukoglu Feyzi Owen Andrew Hemmerling Thomas |
| author_facet | Artukoglu Feyzi Owen Andrew Hemmerling Thomas |
| author_sort | Artukoglu Feyzi |
| collection | DOAJ |
| description | 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 µg/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 patient′s postoperative course was uneventful. We theorize that stress caused by sudden surgical pain stimulus (introduction of the endoscope into the articulation), superficial anaesthesia and insufficient analgesia created a stressful event which probably might have caused a catecholamine surge as basis of Tako-tsubo syndrome. |
| first_indexed | 2024-12-20T18:05:18Z |
| format | Article |
| id | doaj.art-72bbb3e27f4a438fb72a4345c06298c8 |
| institution | Directory Open Access Journal |
| issn | 0971-9784 |
| language | English |
| last_indexed | 2024-12-20T18:05:18Z |
| publishDate | 2008-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Cardiac Anaesthesia |
| spelling | doaj.art-72bbb3e27f4a438fb72a4345c06298c82022-12-21T19:30:34ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842008-01-011113841Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgeryArtukoglu FeyziOwen AndrewHemmerling ThomasWe 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 µg/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 patient′s postoperative course was uneventful. We theorize that stress caused by sudden surgical pain stimulus (introduction of the endoscope into the articulation), superficial anaesthesia and insufficient analgesia created a stressful event which probably might have caused a catecholamine surge as basis of Tako-tsubo syndrome.http://www.annals.in/article.asp?issn=0971-9784;year=2008;volume=11;issue=1;spage=38;epage=41;aulast=ArtukogluGeneral anaesthesiaTako-Tsubo syndromebroken heart syndromemyocardial stunning |
| spellingShingle | Artukoglu Feyzi Owen Andrew Hemmerling Thomas Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery Annals of Cardiac Anaesthesia General anaesthesia Tako-Tsubo syndrome broken heart syndrome myocardial stunning |
| title | Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| title_full | Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| title_fullStr | Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| title_full_unstemmed | Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| title_short | Tako-Tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| title_sort | tako tsubo syndrome in an anaesthetised patient undergoing arthroscopic knee surgery |
| topic | General anaesthesia Tako-Tsubo syndrome broken heart syndrome myocardial stunning |
| url | http://www.annals.in/article.asp?issn=0971-9784;year=2008;volume=11;issue=1;spage=38;epage=41;aulast=Artukoglu |
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