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- Oct 1, 2007
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New CA1 here had a case the other day that still has me wondering what happened.
56 yo male, history of HTN and B-cell lymphoma comes in for a neck dissection/lymph node biopsy.
Patient was induced uneventfully with 120mg propofol, 50 of fentanyl and succinylcholine. No BP issues at this point.
Placed a cobra ETT and the plan was to keep the patient on the deeper side as the surgeon doesn't want the patient paralyzed.
I get the patient to 1.1 MAC and give 50 of fentynl just before incision. Prior to this the BP had been in the 110's.
Within 1 minute his BP tanks and his MAP falls to the 50's. Over the next few minutes I try giving phynlephrine, ephedrine even levophed with no/minimal response. I reduce the gas to 0.8 MAC and hes still hypotensive and nothing is working. Finally I ended up giving epinephrine and was able to get his BP back up.
I ended up having to give intermittent bonuses of epi 1mcg at a time as he wouldn't respond to anything else.
My attending was in the room by the time I was giving levophed and epi and he was thinking it was an adverse reaction to possibly the ancef.
This was a short case (45 min) and magically once we woke the patient up his BP was in the 130's systolic and he was totally fine.
My question is how often do you run across these patients that get profoundly hypotensive and only respond to epinephrine? Is this somewhat common?
56 yo male, history of HTN and B-cell lymphoma comes in for a neck dissection/lymph node biopsy.
Patient was induced uneventfully with 120mg propofol, 50 of fentanyl and succinylcholine. No BP issues at this point.
Placed a cobra ETT and the plan was to keep the patient on the deeper side as the surgeon doesn't want the patient paralyzed.
I get the patient to 1.1 MAC and give 50 of fentynl just before incision. Prior to this the BP had been in the 110's.
Within 1 minute his BP tanks and his MAP falls to the 50's. Over the next few minutes I try giving phynlephrine, ephedrine even levophed with no/minimal response. I reduce the gas to 0.8 MAC and hes still hypotensive and nothing is working. Finally I ended up giving epinephrine and was able to get his BP back up.
I ended up having to give intermittent bonuses of epi 1mcg at a time as he wouldn't respond to anything else.
My attending was in the room by the time I was giving levophed and epi and he was thinking it was an adverse reaction to possibly the ancef.
This was a short case (45 min) and magically once we woke the patient up his BP was in the 130's systolic and he was totally fine.
My question is how often do you run across these patients that get profoundly hypotensive and only respond to epinephrine? Is this somewhat common?