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Severe Hypotension During Induction

Severe Hypotension During Induction

“His arterial BP was 40s/20, HR 90s. Soon the arterial waveform was lost. Both carotid and radial pulses were difficult to palpate. Both IVs were infusing wide open.”

Case Context    Provider Narrative    Contributing Factors    Lessons Learned

Case Context

Patient: older adult male Ht: not provided Wt: not provided
Presenting diagnosis: carotid stenosis
Planned procedure: right carotid endarterectomy
Past medical history: hypertension, previous TIAs, and a stroke within last 3 days leaving no residual effects
Preoperative meds: difficult to determine due to illegible handwriting and the patient could not recall specifics
Other pertinent details: Carotid studies revealed 70% occlusion of his right internal carotid artery and 15% occlusion of his left internal carotid artery. He denied cardiac history and EKG was within normal limits. The most recent blood pressure was 129/67 mmHg. However there was documentation referring to “moderate hypotension” and a blood pressure of 106/58 mmHg had previously been recorded. An 18 gauge peripheral IV was placed and a radial arterial line was secured with difficulty after multiple attempts.
Anesthetic plan: general anesthesia 


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