Key result
General anesthesia induction in a 76-year-old hypovolemic male with undiagnosed coronary artery disease led to severe hypotension, which was resolved after hydration and anticoagulation.
Why the study?
Most anesthetics reduce cardiac functions and lower blood pressure, potentially causing excessive reduction in dehydrated patients or those with coronary artery disease.
Case Report (n=1)
Thorough cardiac evaluation and maintenance of normovolemia are crucial for safe general anesthesia induction in older adults to prevent severe hypotension associated with undiagnosed coronary artery disease.
Answers are grounded in this paper and cite their sources.
May warrant caution during induction in older CAD patients; hypothesis-generating case report that leaves screening implications open.
Most 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, a 76-year-old male patient with undiagnosed CAD in a hypovolemic state experienced a significant drop in systolic BP to the fifties 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 proximal left anterior descending coronary artery (pLAD) 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.
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Ji et al. (2024) conducted a case report in Undiagnosed coronary artery disease in a hypovolemic state (n=1). General anesthesia induction (propofol and sevoflurane) was evaluated on Significant drop in systolic blood pressure. General anesthesia induction in a 76-year-old hypovolemic male with undiagnosed coronary artery disease led to severe hypotension, which was resolved after hydration and anticoagulation.
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