Alina Vilkė, Justina Mikšaitė, Andrius Macas
Orthostatic intolerance defines a group of symptoms characterized by cerebral hypoperfusion and/or sympathetic activation that appear on standing upright and remit in the supine position. Patients may complain of headache, nausea, abdominal pain, lightheadedness, diminished concentration, syncope, anxiety, weakness, fatigue, exercise intolerance, palpitations, dyspnea, and chest pain. POTS criteria: increased heart rate 30 beats/min. or more contractions within the first 10 min of a change in the vertical position, there is no position-induced hypotension, orthostatic intolerance symptoms. POTS is the most common form of orthostatic intolerance. This is the most common syndrome among young people, who have autonomic dysfunction clinic. POTS patients ages – young, between 14 and 45 years. POTS etiology is heterogeneous. It was found that POTS can cause a variety of reasons, but which is primary and which are secondary – remains unclear. We assesed the case: 28 years old patient was hospitalized to Lithuanian University of Health Sciences Kaunas hospital for surgical treatment of esophageal achalasia. The start of surgery (laparoscopic cardiomiotomy) and gas insuffliation was made without any complications. But when the patient‘s position was changed (reverse Tredelenburg) was monitorised atrial flutter (heart rate 130 beats per minute, blood pressure 146/106 mmHg). For atrial flutter correction were used KCl, Mg SO4, and intravenous esmolol. After that, heart rate gradually decreased from 130 beats/ min to 92-80 beats/min. During all surgery, the patient‘s condition was stable, but a normal sinus rhythm observed at the end of operation, when the patient was returned to her primary position. There was a research in Mayo Clinic (Minnesota, USA) which objective – to investigate perioperative patients with postural orthostatic tachycardia syndrome (POTS) preparation, and to identify unexpected complications during operation. The research was conducted on the 152 patients to identify all surgical procedures performed during general anesthesia between January 1, 1993 and December 31, 2006 at Mayo Clinic. There were selected 13 patients (12 women, 1 man) of 152. From research there was found that autonomic dysfunction associated with POTS may present unusual physiologic challenges in the perioperative period.
Keyword(s): change in position; orthostatic tachycardia; hypertension; young age
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