[Hypotension refractory to ephedrine after sympathetic blockade in a patient on long-term therapy with tricyclic antidepressants]

Abstract

A 61-year-old woman in chronic treatment with 25 mg of amitriptyline underwent ovarian cancer resection under combined general and epidural lumbar anesthesia. After administration of local anesthetic she presented signs of severe arterial hypotension that was refractory to high doses of ephedrine and administration of dopamine alpha-adrenergic substances. Control was achieved with 200 micrograms of noradrenaline. We review the anesthetic implications of chronic use of tricyclic antidepressives as they affect choice of vasopressin for treating hypotensive events during anesthesia.