ANAESTHESIA FOR MITRAL VALVOTOMY COMPLICATED BY HYPOTENSION DUE TO PERICARDIAL EFFUSION: Report of two Cases

Abstract

Two cases are described in which unexpected arterial hypotension complicated the management of anaesthesia for surgical correction of mitral stenosis. In each case dramatic improvement followed the release of a bloodstained pericardial effusion. There is often an increased amount of clear pericardial fluid in cases of this type, but this is normally insufficient to cause cardiac embarrassment. Intrapericardial haemorrhage secondary to cardiac catheterization may be a cause of hypotension during anaesthesia. It is important to recognize and anticipate the risks associated with pre-operative catheterization and needle puncture of the heart. Cardiac tamponade is an uncommon complication of anaesthesia, outside accident surgery. Two cases are described in which undiagnosed fluid in the pericardial sac led to difficulty during anaesthesia, prior to its release on incision of the pericardium.