A 74-year-old patient was scheduled for supra umbilical incisional herniorrhaphy.
The only antecedent was untreated arterial hypertension with blood pressure values of 160/90 mm Hg, with electrocardiographic evidence of left ventricular hypertrophy.
General anesthesia was administered, with no incidents up to approximately 20 min after surgery, with a progressive decrease in blood pressure to 50/20 mm Hg, with no response to the administration of 1,000 ml of ringer lactate and repeated doses of 8-12 mg.
Diffuse papular erythema leading to an anaphylactic reaction was detected, and 300 mg hydrocortisone pressure/min was administered 0.2 and 0.3 mg intravenous infusion without recovery, followed by a 0.25ug/kg infusion.
A transesophageal echocardiography (TEE) was performed, which showed a hypertrophic left ventricle with an aortic valve of normal appearance and mobility, and displacement of the anterior valve of the LVOT that determined complete obstruction of the left ventricle.
1,000 ml of Voluven® were rapidly administered, the infusion of lidocaine was stopped and norepinephrine was started up to 2.5 ug/kg/min, resulting in a rapid recovery of acceptable hemodynamic conditions.
At the end of the surgery, the patient was transferred to the intensive care unit, where she gradually decreased until noradrenaline was discontinued and she was discharged 6 h later.
Uh, up to the fifth postoperative day.
