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Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report
During carotid endarterectomy (CEA) surgery, blood pressure management is particularly important to prevent cerebrovascular and cardiac complications. Ephedrine is a commonly used vasopressor, however, we report the case of a patient with unusually severe blood pressure elevation following intraveno...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9981400/ https://www.ncbi.nlm.nih.gov/pubmed/36862890 http://dx.doi.org/10.1097/MD.0000000000033130 |
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author | Kim, Hyunjee Kim, Jeong Eon Yu, Taeyoung |
author_facet | Kim, Hyunjee Kim, Jeong Eon Yu, Taeyoung |
author_sort | Kim, Hyunjee |
collection | PubMed |
description | During carotid endarterectomy (CEA) surgery, blood pressure management is particularly important to prevent cerebrovascular and cardiac complications. Ephedrine is a commonly used vasopressor, however, we report the case of a patient with unusually severe blood pressure elevation following intravenous ephedrine administration during CEA. PATIENT CONCERNS: A 72-year-old man diagnosed with right proximal internal carotid artery stenosis underwent CEA under general anesthesia. After declamping the common carotid artery, blood pressure rapidly increased by 125 mm Hg (from 90 to 215 mm Hg) after ephedrine (4 mg) was administered, but the heart rate was stable. DIAGNOSES: There was an ordinal increase in blood pressure after the same small dose of ephedrine was administered at the early stage of the surgery. And the surgical approach was difficult because he had a high location of carotid bifurcation and a prominent mandibular angle. Because of the anatomical proximity of the cervical sympathetic trunk to the carotid bifurcation and the particularly complicated surgical process in the present case, we postulate the reason for this adverse reaction as transient sympathetic denervation supersensitivity. INTERVENTIONS: Perdipine (0.5 mg) was administered repeatedly to reduce blood pressure. OUTCOMES: After surgery, he was diagnosed with right hypoglossal nerve palsy, and no other abnormal signs were found. CONCLUSION: This case highlights the need for caution in the use of ephedrine, which is commonly used in CEA surgery, wherein blood pressure management is particularly important. Although it is a rare and unpredictable case, α-agonists are considered safer in situations where sympathetic supersensitivity is possible. |
format | Online Article Text |
id | pubmed-9981400 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-99814002023-03-04 Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report Kim, Hyunjee Kim, Jeong Eon Yu, Taeyoung Medicine (Baltimore) 3300 During carotid endarterectomy (CEA) surgery, blood pressure management is particularly important to prevent cerebrovascular and cardiac complications. Ephedrine is a commonly used vasopressor, however, we report the case of a patient with unusually severe blood pressure elevation following intravenous ephedrine administration during CEA. PATIENT CONCERNS: A 72-year-old man diagnosed with right proximal internal carotid artery stenosis underwent CEA under general anesthesia. After declamping the common carotid artery, blood pressure rapidly increased by 125 mm Hg (from 90 to 215 mm Hg) after ephedrine (4 mg) was administered, but the heart rate was stable. DIAGNOSES: There was an ordinal increase in blood pressure after the same small dose of ephedrine was administered at the early stage of the surgery. And the surgical approach was difficult because he had a high location of carotid bifurcation and a prominent mandibular angle. Because of the anatomical proximity of the cervical sympathetic trunk to the carotid bifurcation and the particularly complicated surgical process in the present case, we postulate the reason for this adverse reaction as transient sympathetic denervation supersensitivity. INTERVENTIONS: Perdipine (0.5 mg) was administered repeatedly to reduce blood pressure. OUTCOMES: After surgery, he was diagnosed with right hypoglossal nerve palsy, and no other abnormal signs were found. CONCLUSION: This case highlights the need for caution in the use of ephedrine, which is commonly used in CEA surgery, wherein blood pressure management is particularly important. Although it is a rare and unpredictable case, α-agonists are considered safer in situations where sympathetic supersensitivity is possible. Lippincott Williams & Wilkins 2023-03-03 /pmc/articles/PMC9981400/ /pubmed/36862890 http://dx.doi.org/10.1097/MD.0000000000033130 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | 3300 Kim, Hyunjee Kim, Jeong Eon Yu, Taeyoung Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title | Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title_full | Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title_fullStr | Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title_full_unstemmed | Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title_short | Severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: A CARE-compliant case report |
title_sort | severe blood pressure elevation following ephedrine administration during carotid endarterectomy under general anesthesia: a care-compliant case report |
topic | 3300 |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9981400/ https://www.ncbi.nlm.nih.gov/pubmed/36862890 http://dx.doi.org/10.1097/MD.0000000000033130 |
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