Unexpected myocardial complications after controlled hypotension

Two patients presented with serious myocardial ischemia after controlled hypotension for intracranial aneurysm clipping. Controlled hypotension has been associated with cardiovascular complications in the past. On the basis of their age and medical history, however, these two patients were considered to be at relatively low risk for cardiovascular complications from controlled hypotension, and thus minimal monitoring (i.e., ECG lead II and radial arterial blood pressure) was employed for detection of myocardial ischemia. If controlled hypotension is to be employed during intracranial aneurysm surgery, monitoring for intraoperative myocardial ischemia should be a major consideration of anesthetic management even in the apparently healthy patient.