title: Refractory intraoperative hypotension with elevated serum tryptase.
abstract: Severe intraoperative hypotension has been reported in patients on angiotensin-converting enzyme inhibitors and angiotensin II receptor subtype 1 antagonists. We describe a patient on lisinopril who developed refractory intraoperative hypotension associated with increased serum tryptase level suggesting mast cell activation (allergic reaction). However, allergology workup ruled out an allergic etiology as well as mastocytosis, and hypotension recalcitrant to treatment was attributed to uninterrupted lisinopril therapy. Elevated serum tryptase was attributed to our patient's chronic renal insufficiency.
authors: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Juraj
authors: J
authors: Sprung
authors: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Kelly J
authors: KJ
authors: Larson
authors: Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors: Rohit D
authors: RD
authors: Divekar
authors: Department of Internal Medicine, Mayo Clinic Program for the Study of Mast Cell and Eosinophil Disorders, Mayo Clinic, Rochester, MN 55905, USA.
authors: Joseph H
authors: JH
authors: Butterfield
authors: Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond, VA 23298, USA.
authors: Lawrence B
authors: LB
authors: Schwartz
authors: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Toby N
authors: TN
authors: Weingarten
keywords: Anaphylaxis; Hypotension; Lisinopril; Mastocytosis; Renal insufficiency, Chronic; Tryptase
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