Avoiding Hemodynamic Collapse During Induction of General Anesthesia in a Patient With Unrecognized Cardiac Tamponade: A Case Report

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiac tamponade secondary to malignant pericardial effusion (n=1). Intervention: Pre-induction pericardial drainage under local anesthesia vs. Before pericardial drainage. Primary outcome: Hemodynamic stabilization (systolic arterial blood pressure, mmHg).

Q: What does this research mean for the field?

Pre-induction pericardial drainage under local anesthesia stabilizes hemodynamics and prevents circulatory collapse during subsequent general anesthesia induction in patients with cardiac tamponade. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Itsuki Suganuma; Tomoo Yuba; Katsunao Tanaka; Yu Matsumoto; Akira Iura; Takeshi Yoshida

doi:10.1002/ccr3.73879

November 1, 2026Clinical Case ReportsOpen Access

Avoiding Hemodynamic Collapse During Induction of General Anesthesia in a Patient With Unrecognized Cardiac Tamponade: A Case Report

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Key result

Pre-induction pericardial drainage raises systolic blood pressure by ~21 mmHg, preventing anesthesia-induced hemodynamic collapse.

n=1

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Why the study?

Emergency anesthesia requests may underestimate evolving cardiovascular pathology, creating risk of hemodynamic collapse during induction of general anesthesia when cardiac tamponade is unrecognized.

Key Points

To describe the perioperative recognition and management of unsuspected cardiac tamponade physiology presenting immediately before the induction of general anesthesia.
Case report of a 50-year-old man with bladder cancer and pleural effusion presenting for emergency pleurostomy who showed signs of evolving tamponade physiology in the operating room.
Anesthetic induction was deferred to establish invasive arterial monitoring, measure perfusion index, and perform pre-induction pericardial drainage under local anesthesia before administering remimazolam, remifentanil, and rocuronium.
Bedside evaluation before induction revealed diaphoresis, cool extremities, severe orthopnea, a low perfusion index, and an inspiratory decrease in systolic arterial pressure of approximately 20 mmHg.
Following pre-induction pericardial drainage under local anesthesia, heart rate decreased, systolic arterial pressure and pulse pressure increased, and respiratory variation in arterial pressure diminished.
Subsequent general anesthesia induction and positive-pressure ventilation were completed uneventfully without clinically significant hypotension, and vasopressors were not required.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

A 50-year-old Japanese man with metastatic bladder cancer and progressive malignant pericardial effusion presenting for an emergency pleurostomy under general anesthesia.

I

Intervention

Deferral of general anesthesia induction, independent clinical reassessment, continuous invasive arterial blood pressure monitoring, and urgent multidisciplinary consultation leading to pre-induction pericardial drainage under local anesthesia (evacuating approximately 1000 mL of hemorrhagic pericardial fluid), followed by general anesthesia induction with remifentanil, remimazolam, and rocuronium.

O

Outcome

Hemodynamic stabilization prior to and during the induction of general anesthesia, measured by heart rate, invasive arterial blood pressure, respiratory variation in the arterial pressure waveform, and perfusion index (PI).surrogate

Main Result

Absolute Event Rate: 111% vs 90%

In emergency surgical patients with discordant clinical findings suggesting unrecognized cardiac tamponade, deferring general anesthesia induction to perform rapid reassessment and pre-induction pericardial drainage under local anesthesia can prevent catastrophic hemodynamic collapse.

Limitations

Single-patient case report
Lack of a repeat echocardiographic assessment before transferring the patient to the operating room
Serial CT alone cannot determine the hemodynamic effects of a pericardial effusion
Lack of a repeat echocardiographic assessment before transferring the patient to the operating room during the initial evaluation

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Implication

Alerts to induction risks in tamponade; hypothesis-generating case that leaves generalizability open.

Abstract

Emergency anesthesia requests may underestimate evolving cardiovascular pathology. When bedside findings are discordant with the initial working diagnosis, anesthesiologists should defer induction, reassess independently, and escalate multidisciplinary care before initiating general anesthesia.

Discussion

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Cite This Study

Suganuma et al. (2026) conducted a case report in Cardiac tamponade secondary to malignant pericardial effusion (n=1). Pre-induction pericardial drainage under local anesthesia vs. Before pericardial drainage was evaluated on Hemodynamic stabilization (systolic arterial blood pressure, mmHg). Pre-induction pericardial drainage of 1000 mL fluid improved blood pressure from 90/59 to 111/49 mmHg and perfusion index from 0.42% to 1.24%, preventing hemodynamic collapse during anesthesia.

synapsesocial.com/papers/6aefbd5d50d2071ffda4bd1f https://doi.org/10.1002/ccr3.73879

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Avoiding Hemodynamic Collapse During Induction of General Anesthesia in a Patient With Unrecognized Cardiac Tamponade: A Case Report

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Avoiding Hemodynamic Collapse During Induction of General Anesthesia in a Patient With Unrecognized Cardiac Tamponade: A Case Report

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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