Severe respiratory depression and bradycardia before induction of anesthesia and onset of Takotsubo cardiomyopathy after cardiopulmonary resuscitation

• Published in: Journal of clinical anesthesia 2016-12, Vol.35, p.275-277
• Main Authors: Furuichi, Yuko, MD, PhD, Hamada, Ayaka, MD, Nakazato, Keiko, MD, PhD, Kobayashi, Katsuya, MD, PhD, Sakamoto, Atsuhiro, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia & Perioperative Care; Anesthesia induction; Anesthesia, General - adverse effects; Bradycardia; Bradycardia - chemically induced; Cardiac arrhythmia; Cardiomyopathy; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - adverse effects; Cardiopulmonary Resuscitation - methods; Cataract Extraction; Coronary Angiography; CPR; Drug dosages; Electrocardiography; Epilepsy; Epilepsy - drug therapy; Epinephrine - administration & dosage; Epinephrine - adverse effects; Epinephrine - therapeutic use; Eye surgery; Female; Heart rate; Humans; Hypertension; Hypertension - drug therapy; Hypoxia; Intensive care; Narcotics; Pain; Pain Medicine; Piperidines - administration & dosage; Piperidines - adverse effects; Remifentanil; Respiratory depression; Respiratory Insufficiency - chemically induced; Takotsubo cardiomyopathy; Takotsubo Cardiomyopathy - diagnosis; Takotsubo Cardiomyopathy - etiology; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - adverse effects; Vasoconstrictor Agents - therapeutic use; Ventilators; β-Blocker
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.08.007

Abstract A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. Approximately 2 minutes after an intravenous line was established by an anesthesia resident, severe hypoxia and bradycardia developed, and she lost consciousness. Cardiopulmonary resuscitation was initiated immediately, and after 1 minute, she regained consciousness, and her breathing and circulation recovered. After admission to the intensive care unit, emergency coronary angiography was performed. The blood flow in all the coronary arteries was normal. However, a decrease in the apical left ventricular wall motion and an increase in the basal wall motion were observed. Based on these findings, Takotsubo cardiomyopathy was diagnosed. The wall motion gradually improved and the patient was discharged from the hospital on postoperative day 15. The respiratory depression and bradycardia were thought to be due to an inadvertent bolus of remifentanil. We surmised that the patient had received a slight amount of retained medication when the anesthesia resident established the intravenous line, which caused severe respiratory depression. It is important to note that adverse effects such as severe respiratory depression and bradycardia can be caused by even small doses of remifentanil.