• Anaesth Intensive Care · Feb 2006

    Case Reports

    Refractory hypotension during combined general and epidural anaesthesia in a patient on tricyclic antidepressants.

    • K Takakura, M Nagaya, M Mori, H Koga, S Yoshitake, and T Noguchi.
    • Department of Anaesthesiology, Faculty of Medicine, Oita University, Oita, Japan.
    • Anaesth Intensive Care. 2006 Feb 1;34(1):111-4.

    AbstractWe report a case of refractory hypotension that occurred after epidural injection of local anaesthetic, in a patient who was receiving tricyclic antidepressant therapy and was under general anaesthesia. The patient failed to respond to repeated injections of appropriate doses of sympathomimetics, but did respond to high-dose catecholamine infusions. We suggest that epidural anaesthesia should be used with care when combined with general anaesthesia for patients on long-standing tricyclic antidepressant therapy. If refractory hypotension should occur in such patients, the use of direct-acting vasoconstrictors such as noradrenaline should be considered.

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