[Refractory hypotension during anesthesia in a patient treated with angiotensin receptor blockers]

A 66-year-old woman treated with valsartan, an angiotensin II receptor blocker, and diuretics was scheduled for surgery to remove a pelvic mass. Both drugs were withdrawn 24 hours before anesthetic induction. Combined general and epidural anesthesia was provided. When hypotension developed and was refractory to fluid replacement and phenylephrine administration, terlipressin, a vasopressin receptor antagonist, was infused and outcome was favorable. Anesthetized patients treated with angiotensin II receptor blockers to control hypertension may experience hypotensive events that are refractory to standard treatment but that respond to vasopressin receptor antagonists.