The patient was a 66 y/o female scheduled for a THA under GETA, periarticular block for analgesia. Her past medical history was remarkable for HTN, DM, Sz D/O. Paientt weight was 80 kg. Her case proceeded uneventfully until several minutes after the surgeon injected 200 mg of ropivacaine as part of the periarticular block. The patients heart rate dropped from 70 to 50 to 28. Atropine 1 mg was given, followed by epinephrine 0.4 mg. Chest compressions were administered briefly. The patient became tachycardic and hypertensive. The surgeons closed the incision rapidly. The heart rhythm remained rapid with multfocal ectopy. Liposyn 100 ml was administered and an additional 150 ml of liposyn was given slowly by infusion. The ectopy resolved within 20 minutes of the event . Heart rate stabilized at around 70 bpm. Blood pressure decreased to 80s/40s. Albumin was given and dopamine 5mk/m was started with increase of bp to 100s/50s. The patient was extubabed awake and moving all extremities. She complained of hip pain. She was admitted to the ICU where she continued to need dopamine for hypotension. Her troponin level was elevated. An echocardiogram was remarkable for decreased LV function (35%) and findings consistent with Takotsubo syndrome.
The patient was extubabed awake and moving all extremities. She complained of hip pain. She was admitted to the ICU where she continued to need dopamine for hypotension. Her troponin level was elevated. An echocardiogram was remarkable for decreased LV function (35%) and findings consistent with Takotsubo syndrome.