Tako-Tsubo syndrome secondary to residual neuromuscular blockade. Case report.
| Autor: | Cruvinel MG; Hospital Lifecenter, Belo Horizonte, MG. marcoscruvinel@uai.com.br, Carneiro FS, Bessa RC Jr, Pereira e Silva Y, Marques MB |
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| Jazyk: | English; Portuguese |
| Zdroj: | Revista brasileira de anestesiologia [Rev Bras Anestesiol] 2008 Nov-Dec; Vol. 58 (6), pp. 623-30. |
| DOI: | 10.1590/s0034-70942008000600007 |
| Abstrakt: | Background and Objectives: Tako-Tsubo syndrome is a rare postoperative complication with a 5% mortality rate. The objective of this report was to present residual neuromuscular blockade as a trigger for this syndrome, discuss this disorder, and call attention to the risks of residual neuromuscular blockade. Case Report: A 61-year old female, physical status ASA I, who underwent general anesthesia associated with paravertebral cervical block for arthroscopic repair of a rotator cuff lesion. Physical exam after extubation detected residual neuromuscular blockade. In the post-anesthetic care unit the patient developed somnolence, tachycardia, hypertension, and severe respiratory acidosis. After reintubation the patient evolved for cardiac arrest with electrical activity without a pulse, which was reverted with the administration of adrenaline and external cardiac massage. In the postoperative period the patient presented elevation of the ST segment, increased troponin, and left ventricular medial-apical akinesia with an estimated ejection fraction of 30%. Cardiac catheterization showed absence of significant atheromatous lesions in the coronary vessels, and severe disruption of the systolic function with inferior and antero-septo-apical akinesia and compensatory basal hypercontractility. The patient had complete functional recovery with the treatment instituted. Conclusions: Residual neuromuscular blockade associated with diaphragmatic paralysis and possible pulmonary atelectasis leading to respiratory failure, hypercapnia, and adrenergic discharge triggered the Tako-Tsubo syndrome with severe clinical repercussion. |
| Databáze: | MEDLINE |
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