Minimizing stress with remifentanil in a patient with Takotsubo undergoing ophthalmic surgery

Anesthesiological management of patients with Takotsubo syndrome (TTS) is a challenge of questions related to physiopathology, prognosis, and trigger causes. Relative rarity of this disease and lack of wide literature do not allow to state any negative or positive effect of the variety of drugs available for anesthesia. The authors report a case of a woman with a clear diagnosis of TTS and anxiety disorder, who underwent to cataract extractions at both eyes at two different times. Clinical management is described, from preoperative assessment until discharge of the patient. In both cases, surgery was successfully performed using remifentanil Target Controlled Infusion sedation in spontaneous ventilation. In this article, the authors suggest the possible cardioprotective role of remifentanil in this kind of pathology, focusing on its advantageous sedating action that guarantees a stress-free condition, while maintaining control on respiratory drive.