Refractory hypotension during combined general and epidural anaesthesia in a patient on tricyclic antidepressants.
We report a case of refractory hypotension that occurred after epidural injection of local anaesthetic, in a patient who was receiving tricyclic antidepressant therapy and was under general anaesthesia. The patient failed to respond to repeated injections of appropriate doses of sympathomimetics, but did respond to high-dose catecholamine infusions. We suggest that epidural anaesthesia should be used with care when combined with general anaesthesia for patients on long-standing tricyclic antidepressant therapy. If refractory hypotension should occur in such patients, the use of direct-acting vasoconstrictors such as noradrenaline should be considered.
Department of Anaesthesiology, Faculty of Medicine, Oita University, Oita, Japan.
K
K
Takakura
M
M
Nagaya
M
M
Mori
H
H
Koga
S
S
Yoshitake
T
T
Noguchi
D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy*; D004347:Drug Interactions; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D009638:Norepinephrine / Q000627:therapeutic use; D018570:Risk Assessment; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009638:Norepinephrine