title: [Severe hypotension and ventricular fibrillation during combined general and epidural anesthesia in a patient on major tranquilizers].
abstract: A 54-year-old man (height 155 cm, weight 49 kg) was scheduled for retroperitoneoscopic nephrectomy. He had a history of schizophrenia that had been controlled with propericiazine 10 mg and bromperidol 3 mg daily for 34 years. After induction of anesthesia, 1% mepivacaine 5 ml was administered via an epidural catheter. Blood pressure decreased 15 minutes later to 47/25 mmHg and heart rate dropped to 50 beats x min(-1). Ventricular fibrillation occurred despite titrated injection of ephedrine (40 mg total), phenylephrine (1 mg total), atropine (0.5 mg total), and rapid infusion of crystalloid and colloid solutions. Chest compression and defibrillation were required to restore spontaneous circulation. Surgery was cancelled and he was extubated 45 minutes later without any complications. These findings suggest that caution must be exercised when combining general and epidural anesthesia for patients on long-term major tranquilizers. In the event of refractory hypotension, the use of direct-acting vasoconstrictors such as noradrenaline or vasopressin should be considered.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, Oita University, Yufu 879-5593.
authors.forename: Kanako
authors.initials: K
authors.lastname: Futsukaichi
authors.forename: Koji
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fujita
authors.forename: Ryuji
authors.initials: R
authors.lastname: Abe
authors.forename: Takayuki
authors.initials: T
authors.lastname: Noguchi
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006220:Haloperidol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010640:Phenothiazines / Q000008:administration & dosage / Q000009:adverse effects*; D012559:Schizophrenia / Q000188:drug therapy; D012720:Severity of Illness Index; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000209:etiology*
chemical_list: D014150:Antipsychotic Agents; D010640:Phenothiazines; C084584:periciazine; D006220:Haloperidol; C006820:bromperidol