Refractory Hypotension Following Sublingual Isosorbide Dinitrate in the Postoperative Period in a Patient with Ischaemic Heart Disease

Anaesthetic management of patients with ischaemic heart disease for noncardiac surgery can be associated with many cardiovascular complications. Sublingual isosorbide dinitrate remains one of the mainstays of management in patients with angina and acute coronary syndrome. Here we present a case with ischemic heart disease, scheduled for non cardiac surgery, who received isosorbide dinitrate in the postoperative period and developed severe hypotension. The patient was known case of hypertension and ischemic heart disease which were controlled on medications. Dynamic hip screw fixation of left femur was done under spinal anaesthesia. There was one intraoperative episode of hypotension which was managed with vasopressor and inotrope. In the postoperative period, patient developed chest pain for which sublingual isosorbide dinitrate was given as per cardiologist's advice. He developed immediate drop of blood pressure which did not respond to fluid, blood transfusion or vasopressors. Later, she was transferred to intensive care unit where she required ventilatory support and correction of metabolic acidosis. After two days she was weaned off all vasopressor infusions and ventilatory support. This case report indicates that sublingual isosorbide dinitrate may cause Keywords: Hypotension; Isosorbide dinitrate; Post-op period; Acute coronary syndrome severe hypotension refractory to vasopressor in the postoperative period in patients with ischemic heart disease and coexisting anemia.