Cardiovascular collapse during anesthesia in a patient with preoperatively discontinued chronic MAO inhibitor therapy |
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Authors: | Juraj Sprung MD PhD David Distel CRNA Jeffrey Grass MD Eric L. Bloomfield MD Ian C. Lavery MD |
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Affiliation: | Department of General Anesthesiology and Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA |
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Abstract: | We describe a patient in whom long-term monoamine oxidase (MAO) inhibitor therapy was discontinued 20 days before surgery with general anesthesia. This patient developed severe perioperative hypotension after administration of 10 mg of bupivacaine through an epidural catheter, which was corrected only after potent vasopressor therapy. We attribute this hemodynamic instability to attenuation of this patient's sympathetic tone based on several mechanisms: (1) residual effect of long-term administration of MAO inhibitor that caused a decrease in the number of β-adrenergic receptors (adrenergic subsensitivity due to receptor down-regulation), (2) recovered MAO activity causing effective degradation of sympathetic amines, and (3) combined attenuating effects of general and epidural anesthesia on sympathetic tone. |
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Keywords: | Anesthesia epidural general complication hypotension monoamine oxidase inhibitors tranylcypromine |
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