PMID- 31346152
OWN - NLM
STAT- MEDLINE
DCOM- 20200129
LR  - 20231013
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 20
DP  - 2019 Jul 26
TI  - Ephedrine-Induced Increases in Blood Pressure and Heart Rate Due to Suspected 
      Cardiac Sympathetic Denervation Supersensitivity in a Patient with Parkinson's 
      Disease Under Spinal Anesthesia.
PG  - 1104-1107
LID - 10.12659/AJCR.916188 [doi]
AB  - BACKGROUND Denervation supersensitivity to sympathomimetic drugs has been noted 
      in patients with Parkinson's disease (PD) whose cardiac sympathetic nerves are 
      denervated. This phenomenon is not as well recognized as other complications of 
      PD patients, but anesthesiologists should be aware of it because sympathomimetic 
      drugs can sometimes be dangerous to these patients. CASE REPORT A 60-year-old 
      woman was scheduled for total hip joint replacement under combined 
      spinal-epidural anesthesia and sedation. She had been diagnosed as PD (stage 4 on 
      the Hoehn and Yahr scale) with a history of orthostatic hypotension. Her 
      (1)(2)(3)I-metaiodobenzylguanidine (MIBG) scintigraphy revealed marked reduction of 
      (1)(2)(3)I-MIBG accumulation in the heart. In the operating room, we placed an epidural 
      catheter through the Th12-L1 space, and spinal anesthesia (2.6 mL of 0.5% 
      normobaric bupivacaine) was administered. During the surgery, we infused propofol 
      at 100 mg.hr(-)(1) for sedation. When 4 mg of ephedrine was administered 
      intravenously because of marked decrease in patient's blood pressure, we observed 
      unexpectedly large increases in the systolic blood pressure, from 78 mmHg to 168 
      mmHg, and the heart rate increased from 52 to 84 beats per minute (bpm). This 
      phenomenon recurred each time 4 mg of ephedrine was administered. CONCLUSIONS We 
      report a case in which ephedrine induced unexpectedly large increases in blood 
      pressure and heart rate in a patient who suffered from PD with severe cardiac 
      sympathetic nerve denervation. We speculate that this phenomenon was caused by 
      denervation supersensitivity of the patient's heart.
FAU - Kitaura, Atsuhiro
AU  - Kitaura A
AD  - Department of Anesthesiology, Kindai University Faculty of Medicine, 
      Osaka-Sayama, Osaka, Japan.
FAU - Houri, Kei
AU  - Houri K
AD  - Department of Anesthesiology, Kindai University Faculty of Medicine, 
      Osaka-Sayama, Osaka, Japan.
FAU - Nakao, Shinichi
AU  - Nakao S
AD  - Department of Anesthesiology, Kindai University Faculty of Medicine, 
      Osaka-Sayama, Osaka, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20190726
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Sympathomimetics)
RN  - GN83C131XS (Ephedrine)
SB  - IM
MH  - Anesthesia, Spinal
MH  - Ephedrine/administration & dosage/*adverse effects
MH  - Female
MH  - Heart/innervation
MH  - Heart Rate/*drug effects
MH  - Humans
MH  - Hypertension/*chemically induced
MH  - Middle Aged
MH  - Parkinson Disease/*complications
MH  - Sympathomimetics/administration & dosage/*adverse effects
PMC - PMC6676985
COIS- Conflict of interest: None declared Conflicts of interest None
EDAT- 2019/07/28 06:00
MHDA- 2020/01/30 06:00
PMCR- 2019/07/26
CRDT- 2019/07/27 06:00
PHST- 2019/07/27 06:00 [entrez]
PHST- 2019/07/28 06:00 [pubmed]
PHST- 2020/01/30 06:00 [medline]
PHST- 2019/07/26 00:00 [pmc-release]
AID - 916188 [pii]
AID - 10.12659/AJCR.916188 [doi]
PST - epublish
SO  - Am J Case Rep. 2019 Jul 26;20:1104-1107. doi: 10.12659/AJCR.916188.