[Anesthetic management of a patient with severe subarachnoid hemorrhage and diffuse lung edema]

One of the most common problems in emergency anesthesia for cerebral aneurysm surgery is clinically significant ECG abnormalities. We had a 58 year old patient with severe subarachnoid hemorrhage and diffuse lung edema leading to fatal outcome probably due to catecholamine myocardial injury. During the operative intervention with enflurane and oxygen anesthesia, ST elevation on ECG suddenly appeared and heart failure developed in this patient. Intraoperative ECG suggested the development of acute myocardial infarction of the anterior and inferior wall, but echocardiography revealed a discrepant result; the wall motion abnormality was confirmed in the apex only. The serum CPK in this patient increased a little over the normal limit perioperatively. Overall results suggested that a cause of this patient's death was myocardial injury due to the excessive release of catecholamine. Therefore, we urge the need of through cardiac examinations as well as the administration of preventive drugs for catecholamine myocardial injury in the perioperative management of patients with severe subarachnoid hemorrhage.