Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia Induction: A Case Report

• Published in: Medicina (Kaunas, Lithuania) Vol. 60; no. 2; p. 232
• Main Authors: Ji, Jae Young, Seo, Yong Han, Jung, Ho Soon, Chun, Hea Rim, Park, Jin Soo, Kim, Woo Jong, Ahn, Jae Min, Park, Yu Jun, Shin, Ye Eun, Park, Chan Ho
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01.01.2024
• Subjects: Aged; Anesthesia; Anesthesia, General - adverse effects; Anesthetics; Anesthetics, Intravenous; Blood Pressure; Cardiovascular disease; Case reports; coronary artery disease; Coronary Artery Disease - complications; Coronary heart disease; Coronary Occlusion; Coronary vessels; dehydration; Diabetes; Ejection fraction; Electrocardiography; General anesthesia; Heart; Humans; Hypertension; Hypotension; Intubation; Ischemia; Joint surgery; Male; Mortality; Propofol; Pulse oximetry; sevoflurane; Type 2 diabetes; Valsartan; South Korea; coronary artery disease; dehydration; sevoflurane; propofol
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina60020232

Most anesthetics reduce cardiac functions and lower blood pressure (BP), potentially causing excessive BP reduction in dehydrated patients or those with heart conditions, such as coronary artery disease (CAD). Considering the increased prevalence of cardiovascular disease with age, anesthesiologists must be cautious about BP reduction during general anesthesia in older adults. In the present case, a 76-year-old male patient with undiagnosed CAD in a hypovolemic state experienced a significant drop in systolic BP to the fifties during propofol and sevoflurane anesthesia. Despite the use of vasopressors, excessive hypotension persisted, leading to anesthesia suspension. Subsequent cardiac examinations, including computed tomography heart angio and calcium score, and coronary angiogram, revealed a near total occlusion of the proximal left anterior descending coronary artery (pLAD) and the formation of collateral circulation. After 5 days of hydration and anticoagulation medications and confirmation of normovolemic state, general anesthesia was attempted again and successfully induced; a normal BP was maintained throughout the surgery. Thus, it is important to conduct a thorough cardiac evaluation and maintain normovolemia for general anesthesia in older adults.