Tako-Tsubo syndrome secondary to residual neuromuscular blockade. Case report

Tako-Tsubo syndrome is a rare postoperative complication with a 5% mortality rate. The objective of this report was to present residual neuromuscular blockade as a trigger for this syndrome, discuss this disorder, and call attention to the risks of residual neuromuscular blockade. A 61-year old fema...

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Veröffentlicht in:Revista brasileira de anestesiologia 2008-11, Vol.58 (6), p.623-630
Hauptverfasser: Cruvinel, Marcos Guilherme Cunha, Carneiro, Fabiano Soares, Bessa, Jr, Roberto Cardoso, Pereira e Silva, Yerkes, Marques, Mirna Bastos
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container_issue 6
container_start_page 623
container_title Revista brasileira de anestesiologia
container_volume 58
creator Cruvinel, Marcos Guilherme Cunha
Carneiro, Fabiano Soares
Bessa, Jr, Roberto Cardoso
Pereira e Silva, Yerkes
Marques, Mirna Bastos
description Tako-Tsubo syndrome is a rare postoperative complication with a 5% mortality rate. The objective of this report was to present residual neuromuscular blockade as a trigger for this syndrome, discuss this disorder, and call attention to the risks of residual neuromuscular blockade. A 61-year old female, physical status ASA I, who underwent general anesthesia associated with paravertebral cervical block for arthroscopic repair of a rotator cuff lesion. Physical exam after extubation detected residual neuromuscular blockade. In the post-anesthetic care unit the patient developed somnolence, tachycardia, hypertension, and severe respiratory acidosis. After reintubation the patient evolved for cardiac arrest with electrical activity without a pulse, which was reverted with the administration of adrenaline and external cardiac massage. In the postoperative period the patient presented elevation of the ST segment, increased troponin, and left ventricular medial-apical akinesia with an estimated ejection fraction of 30%. Cardiac catheterization showed absence of significant atheromatous lesions in the coronary vessels, and severe disruption of the systolic function with inferior and antero-septo-apical akinesia and compensatory basal hypercontractility. The patient had complete functional recovery with the treatment instituted. Residual neuromuscular blockade associated with diaphragmatic paralysis and possible pulmonary atelectasis leading to respiratory failure, hypercapnia, and adrenergic discharge triggered the Tako-Tsubo syndrome with severe clinical repercussion.
doi_str_mv 10.1590/S0034-70942008000600007
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subjects Female
Humans
Middle Aged
Nerve Block - adverse effects
Takotsubo Cardiomyopathy - etiology
title Tako-Tsubo syndrome secondary to residual neuromuscular blockade. Case report
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