Sedat HAKİMOGLU, Onur KOYUNCU, Cagla AKKURT, Sumeyra YESİL, Senem URFALİ

Anesthesia management for emergency cesarean section in a patient with takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TCM) is a clinical entity resembling acute myocardial infarction that develops due to catecholamine discharge and coronary artery spasm following acute stress in postmenopausal women. The most common symptoms are chest pain, syncope and dyspnea. Moreover ST interval and T wave abnormalities are frequently seen on electrocardiogram (ECG). 19-year-old pregnant with TCM undervent for emergency caesarean section (C/S). Ejection fraction was measured 60% in preoperative echocardiography. Anesthesia induction was achieved with 2 mg/kg propofol and 1 mg/kg fentanyl, after rapid serial endotracheal intubation was performed by using 1.2 mg/kg rocuronium bromide. Anesthesia was maintained with sevoflurane. Residual block was reversed by 4 mg/kg dose of sugammadex and there was no there was complication in the perioperative period. In anesthesia management of patients with TCM, minimization of situations that caused an increase in catecholamine, if possible follow-up with advanced cardiac monitoring and it should be postoperative intensive care unit (ICU) preparation

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1. Sato H, Tateishi H, Dote K, et al. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K, Haze K, Hori M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyoronsha Publishing Co. 1990:56-64.

2. Salmoirago-Blotcher E, Dunsiger S, Swales HH, et al. Reproductive History of Women With Takotsubo Cardiomyopathy. Am J Cardiol. 2016;118:1922-8.

3. Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010;35:240-3.

4. K. Dote, H. Sato, H, Tateishi, T, et al. Uchida, and M. Ishihara, Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol. 1991;21:203–14.

5. Gültekin N, Dalgıç Y. Tako-Tsubo Cardiomyopathy, Turkiye Klinikleri J Cardiol-Special Topics. 2016;9:1-7.

6. Küçükdurmaz Z, Karapınar H, Oflaz MB, et al. Our clinical experience of Takotsubo cardiomyopathy and the first case series from Turkey Arch Turk Soc Cardiol. 2013;41:212-7.

7. Deniz S, Bakal Ö, İnangil G, et al. Takotsubo Cardiomyopathy Occurring in the Postoperative Period. Turk J Anaesthesiol Reanim. 2015;43:47–9.