What question did this study set out to answer?

To investigate the cause of a hypertensive crisis with tachycardia during surgery in a healthy male.

April 17, 2026Open Access

Intraoperative Hypertensive Crisis with Tachycardia – An Exaggerated Intubation Response or Subclinical Hyperthyroidism Unmasked

Key Points

To investigate the cause of a hypertensive crisis with tachycardia during surgery in a healthy male.
Reported a case of a young male undergoing laparoscopic appendectomy
Administered glycopyrrolate for bradycardia before hypertensive crisis
Treated hypertensive crisis initially with propofol and dexmedetomidine, then with intravenous esmolol
Postoperative thyroid hormone levels were assessed for diagnosis
The hypertensive crisis was not due to an exaggerated intubation response
Thyroid storm was confirmed by elevated postoperative thyroid-stimulating hormone and free T4 levels
Esmolol effectively managed the severe hypertension and tachycardia

Abstract

Abstract We report a case of intraoperative normothermic tachyarrhythmic hypertensive crisis in a young healthy male posted for laparoscopic appendectomy. This hypertensive crisis was induced after glycopyrrolate injection given for bradycardia. We were unable to treat it with repeated doses of propofol and dexmedetomidine; we finally managed with intravenous esmolol, used as a rescue drug for unexplained tachycardia and severe hypertension. It was found to be an unusual presentation of thyroid storm, rather than an exaggerated response to tracheal intubation or to glycopyrrolate, as confirmed by postoperative thyroid-stimulating hormone and free T4 levels.

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