Perioperative management of a patient requiring surgery for pituitary apoplexy and severe angina pectoris

We describe the management of a 71-yr-old man with pituitaryapoplexy and severe angina pectoris who underwent treatmentof an intra-cranial haemorrhage and open-heart surgery requiringanticoagulant therapy within a very short period. Subtotal removalof the pituitary tumour was undertaken under stable cardiovascularconditions. But ventricular fibrillation occurred after theneurosurgery in the intensive care unit. After the patient wasdefibrillated, intra-aortic balloon pumping was necessary toassist coronary artery blood flow. Twenty hours after neurosurgery,oozing from the surgical wound stopped and coronary artery bypassgrafting with full heparinization was performed uneventfully. Br J Anaesth 2000; 85: 800–2 ^* Corresponding author