title: An unusual cause of acute chest pain during epidural anesthesia.
abstract: OBJECTIVE
  Selective sympathetic denervation during epidural anesthesia results in a small, active gut. These changes can also result in selective activity in one segment of the gut that is absent in other segments.
  
  
  METHODS
  A 61-year-old male was scheduled for bilateral total knee replacement during epidural anesthesia. Following onset of the epidural block, he experienced severe left-sided chest pain. Surgery was canceled. A portable chest radiograph revealed a widened mediastinum, and he underwent angiography to rule out a dissecting thoracic aortic aneurysm. The left subclavian artery could not be visualized, and an MRI was obtained, which was normal. After his return to the intensive care unit, he had a large bowel movement and his chest pain resolved.
  
  
  CONCLUSIONS
  Selective activity of the gastrointestinal tract during the onset of epidural anesthesia created a visceral pain, which effectively simulated pain with a cardiovascular origin.
authors.affiliation: Pain Management Center and Department of General Anesthesiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: E
authors.initials: E
authors.lastname: Yap
authors.forename: J
authors.initials: J
authors.lastname: Dilger
authors.forename: J E
authors.initials: JE
authors.lastname: Tetzlaff
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D002637:Chest Pain / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged