Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia induction:A Case Report

Jae Young Ji
* ,
Yong Han Seo
ORCID logo ,
Ho Soon Jung
,
Hea Rim Chun
,
Jin Soo Park
ORCID logo ,
Woo Jong Kim
ORCID logo ,
Jae Min Ahn
,
Yu Jun Park
,
Ye Eun Shin
,
Chan Ho Park
Version 1 : Received: 10 January 2024 / Approved: 10 January 2024 / Online: 11 January 2024 (11:27:54 CET)

A peer-reviewed article of this Preprint also exists.

Ji, J.Y.; Seo, Y.H.; Jung, H.S.; Chun, H.R.; Park, J.S.; Kim, W.J.; Ahn, J.M.; Park, Y.J.; Shin, Y.E.; Park, C.H. Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia Induction: A Case Report. Medicina 2024, 60, 232. Ji, J.Y.; Seo, Y.H.; Jung, H.S.; Chun, H.R.; Park, J.S.; Kim, W.J.; Ahn, J.M.; Park, Y.J.; Shin, Y.E.; Park, C.H. Coronary Artery Occlusion with Sharp Blood Pressure Drop during General Anesthesia Induction: A Case Report. Medicina 2024, 60, 232.

Abstract

Anesthetics reduce cardiac functions and lower blood pressure (BP), potentially causing excessive BP reduction in dehydrated patients or those with heart conditions, such as coronary artery disease (CAD). Considering the increased prevalence of cardiovascular disease with age, anesthesiologists must be cautious about BP reduction during general anesthesia in older adults. In the present case, an undiagnosed CAD patient in a hypovolemic state experienced a significant systolic blood pressure drop to the 50s during propofol and sevoflurane anesthesia. Despite the use of vasopressors, excessive hypotension persisted, leading to anesthesia suspension. Subsequent cardiac examinations, including computed tomography heart angio and calcium score, and coronary angiogram, revealed a near total occlusion of the left main coronary artery and the formation of collateral circulation. After 5 days of hydration and anticoagulation medications and confirmation of normovolemic state, general anesthesia was attempted again and successfully induced; a normal BP was maintained throughout the surgery. Thus, it is important to conduct a thorough cardiac evaluation and maintain normovolemia for general anesthesia in older adults.

Keywords

Coronary artery disease; Dehydration; Propofol; Sevoflurane

Subject

Medicine and Pharmacology, Anesthesiology and Pain Medicine

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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