Журнал хирургии и анестезии

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Occurrence of Takotsubo Cardiomyopathy after Nasal Administration of Lidocaine with Epinephrine in an Outpatient Surgery Center: A Case Report

Giulia Sikorski, The-Hung Edward Nguyen

Although outpatient surgeries are safe, providers must always be vigilant for rare, life-threatening conditions that might need immediate diagnosis, treatment, and possible transfer of the patient to a higher level of care. We present the case of a 37-year-old woman who presented to an outpatient center for nasal surgery. Induction of general anesthesia was uneventful. However, after receiving an intranasal injection of local anesthesia with epinephrine Just prior to the surgical incision, she developed profound hypertension and subsequent Cardio vascular instability that required emergent transfer to the emergency department and then an intensive unit care. Transthoracic echocardiography showed marked impairment in cardiac Motion and severely reduced ejection fraction, which improved a few days later and returned to Normal within a month. The patient was diagnosed with Takotsubo cardiomyopathy (TC), a non-Ischemic cardiomyopathy that can result from severe stress. Administration of local anesthetic with epinephrine can lead to TC during common, elective outpatient procedures in healthy ASA 1 patients. In an outpatient surgery center where resources for acute care may be limited, TC should be recognized quickly and treated by the anesthesiologist. Prompt transfer of the patient to an acute care facility can prevent longterm sequelae.