Perioperative approach of patient with takotsubo syndrome / Abordagem perioperatória de doente com síndrome de takotsubo

Abstract Introduction: Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy. It is characterized by an acute onset of symptoms and electrocardiographic abnormalities mimicking an acute coronary syndrome in the absence of obstructive coronary artery disease. Any anesthetic-surgical event corresponds to a stressful situation, so the anesthetic management of patients with TCM requires special care throughout the perioperative period. We describe the anesthetic management of a patient with a confirmed diagnosis of TCM undergoing segmental colectomy. Case report: Female patient, 55 years old, ASA III, with history of takotsubo syndrome diagnosed 2 years ago, scheduled for segmental colectomy. The patient, without other changes in preoperative evaluation, underwent general anesthesia associated with lumbar epidural and remained hemodynamically stable during the 2 h of surgery. After a brief stay in the Post-Anesthesia Care Unit, she was transferred to the Intermediate Care Unit (IMCU), with epidural analgesia for postoperative period. Conclusion: TCM is a rare disease which true pathophysiology remains unclear, as well as the most appropriate anesthetic-surgical strategy. In this case, through a preventive approach, with close monitoring and the lowest possible stimulus, all the perioperative period was uneventful. Because it is a rare disease, this report could help to raise awareness about TCM.

Resumo Introdução: A miocardiopatia takotsubo (MT) é uma miocardiopatia induzida pelo estresse. Caracteriza-se por um início agudo de sintomas e alterações eletrocardiográficas que mimetizam uma síndrome coronária aguda na ausência de doença arterial coronária obstrutiva. Qualquer evento anestésico-cirúrgico corresponde a uma situação de estresse, pelo que a abordagem anestésica dos doentes com MT exige um cuidado especial em todo o período perioperatório. Descrevemos a abordagem anestésica de uma doente com diagnóstico confirmado de MT submetida a colectomia segmentar. Caso clínico: Paciente do sexo feminino, 55 anos, ASA III, com antecedentes de síndrome de takotsubo diagnosticada havia dois anos, encaminhada para colectomia segmentar. A paciente, sem outras alterações na avaliação pré-operatória, foi submetida a anestesia geral associada a epidural lombar e manteve-se hemodinamicamente estável durante as duas horas do procedimento cirúrgico. Após uma breve permanência na Unidade de Cuidados Pós-Anestésicos foi transferida para a Unidade de Cuidados Intermédios (UCIM) com analgesia peridural para o pós-operatório. Conclusão: A MT é uma doença rara, cuja verdadeira fisiopatologia continua por esclarecer, assim como a estratégia anestésico-cirúrgica mais apropriada. Nesse caso, por causa de uma abordagem preventiva, com monitoração rigorosa e o menor estímulo possível, todo o perioperatório decorreu sem intercorrências. Sendo uma doença rara, o seu relato poderá contribuir para o avanço do conhecimento sobre a MT.

[Perioperative approach of patient with takotsubo syndrome]. / Abordagem perioperatória de doente com síndrome de takotsubo.

INTRODUCTION: Takotsubo cardiomyopathy (TCM) is a stress-induced cardiomyopathy. It is characterized by an acute onset of symptoms and electrocardiographic abnormalities mimicking an acute coronary syndrome in the absence of obstructive coronary artery disease. Any anesthetic-surgical event corresponds to a stressful situation, so the anesthetic management of patients with TCM requires special care throughout the perioperative period. We describe the anesthetic management of a patient with a confirmed diagnosis of TCM undergoing segmental colectomy. CASE REPORT: Female patient, 55 years old, ASA III, with history of takotsubo syndrome diagnosed 2 years ago, scheduled for segmental colectomy. The patient, without other changes in preoperative evaluation, underwent general anesthesia associated with lumbar epidural and remained hemodynamically stable during the 2hours of surgery. After a brief stay in the Post-Anesthesia Care Unit, she was transferred to the Intermediate Care Unit (IMCU), with epidural analgesia for postoperative period. CONCLUSION: TCM is a rare disease which true pathophysiology remains unclear, as well as the most appropriate anesthetic-surgical strategy. In this case, through a preventive approach, with close monitoring and the lowest possible stimulus, all the perioperative period was uneventful. Because it is a rare disease, this report could help to raise awareness about TCM.