Subendocardial ischemia due to hypertension after induction of general anesthesia

This report identifies acute severe systemic hypertension during surgical procedures as a potential life-threatening event. If the increased myocardial oxygen demand is not met by adequate oxygen supply, either because of underlying coronary artery disease or a hemodynamic state that does not allow adequate augmentation of diastolic coronary blood flow, then subendocardial myocardial ischemia and perhaps infarction will occur, particularly if the described events go unrecognized and untreated. Recognition of severe intraoperative hypertension by hemodynamic monitoring, and early treatment by afterload reduction with vasodilators and perhaps subsequent catecholamine support, are indicated and may save both myocardium and life.