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Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia Induction: A Case Report
Jae Young Ji1, Yong Han Seo1, Ho Soon Jung1
1Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Suncheonhyang 6-gil, Dongam-gu, Cheonan 31151, Republic of Korea.
Medicina (Kaunas, Lithuania)
|February 24, 2024
Summary
Anesthetic-induced hypotension in older adults with undiagnosed coronary artery disease (CAD) can be severe. Preoperative cardiac evaluation and maintaining adequate hydration are crucial for safe general anesthesia in elderly patients.
Area of Science:
- Cardiology
- Anesthesiology
- Geriatric Medicine
Background:
- General anesthesia commonly reduces blood pressure (BP), posing risks for elderly patients with cardiovascular conditions like coronary artery disease (CAD).
- Older adults have a higher prevalence of cardiovascular disease, necessitating careful anesthetic management to avoid excessive BP reduction.
Observation:
- A 76-year-old male with undiagnosed CAD in a hypovolemic state experienced severe hypotension (systolic BP in the 50s) under propofol and sevoflurane anesthesia.
- Despite vasopressor use, hypotension persisted, leading to anesthesia suspension and further cardiac investigations.
Findings:
- Cardiac imaging revealed near-total occlusion of the proximal left anterior descending coronary artery (pLAD) with collateral circulation.
- Following hydration and anticoagulation, a subsequent anesthesia attempt was successful, maintaining normal BP.
Implications:
- Thorough preoperative cardiac evaluation is essential for older adults undergoing general anesthesia.
- Maintaining normovolemia is critical for preventing severe hypotension during anesthesia in this demographic.
- This case highlights the importance of identifying underlying CAD and addressing hypovolemia before elective procedures.
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