title: Tako-Tsubo syndrome secondary to residual neuromuscular blockade. Case report.
abstract: OBJECTIVE
  Tako-Tsubo syndrome is a rare postoperative complication with a 5% mortality rate. The objective of this report was to present residual neuromuscular blockade as a trigger for this syndrome, discuss this disorder, and call attention to the risks of residual neuromuscular blockade.
  
  
  METHODS
  A 61-year old female, physical status ASA I, who underwent general anesthesia associated with paravertebral cervical block for arthroscopic repair of a rotator cuff lesion. Physical exam after extubation detected residual neuromuscular blockade. In the post-anesthetic care unit the patient developed somnolence, tachycardia, hypertension, and severe respiratory acidosis. After reintubation the patient evolved for cardiac arrest with electrical activity without a pulse, which was reverted with the administration of adrenaline and external cardiac massage. In the postoperative period the patient presented elevation of the ST segment, increased troponin, and left ventricular medial-apical akinesia with an estimated ejection fraction of 30%. Cardiac catheterization showed absence of significant atheromatous lesions in the coronary vessels, and severe disruption of the systolic function with inferior and antero-septo-apical akinesia and compensatory basal hypercontractility. The patient had complete functional recovery with the treatment instituted.
  
  
  CONCLUSIONS
  Residual neuromuscular blockade associated with diaphragmatic paralysis and possible pulmonary atelectasis leading to respiratory failure, hypercapnia, and adrenergic discharge triggered the Tako-Tsubo syndrome with severe clinical repercussion.
authors.affiliation: Hospital Lifecenter, Belo Horizonte, MG. marcoscruvinel@uai.com.br
authors.forename: Marcos Guilherme Cunha
authors.initials: MG
authors.lastname: Cruvinel
authors.forename: Fabiano Soares
authors.initials: FS
authors.lastname: Carneiro
authors.forename: Roberto Cardoso
authors.initials: RC
authors.lastname: Bessa
authors.forename: Yerkes
authors.initials: Y
authors.lastname: Pereira e Silva
authors.forename: Mirna Bastos
authors.initials: MB
authors.lastname: Marques
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology*