Korean J Anesthesiol.  2008 Aug;55(2):229-232. 10.4097/kjae.2008.55.2.229.

Left subclavian artery stenosis found by the interarm blood pressure difference during combined spinal-epidural anesthesia of patient with peripheral vascular disease: A case report

• Kim YH
• Lim SH
• Lee JI
• Lee SE
• Kim YH
• Lee JH
• Lee KM
• Cheong SH
• Choe YK
• Kim YJ
• Shin CM

• KMID: 2299209
• DOI: http://doi.org/10.4097/kjae.2008.55.2.229

Abstract

In spite of the American Heart Association recommendations for blood pressure measurement, many physicians measure blood pressure in only one arm that is easy to access at the time of measurement. This practice can lead to incorrect management with significant interarm blood pressure difference. We report a case of a 51 years old man who was scheduled to undergo vascular bypass graft under combined spinal-epidural anesthesia. In 60 minutes after anesthesia, the blood pressure of left arm dropped from 110/65 mmHg to 74/45 mmHg. The blood pressure was still 80/50 mmHg after two injections of ephedrine. After checking radial pulse tone strength, we found significant interarm blood pressure difference. The blood pressure of right arm was 150/70 mmHg. Postoperative CT angiogram revealed significant stenotic portion in the left subclavian artery. This case emphasizes the importance of bilateral blood pressure measurement, especially in patients with peripheral vascular disease.

Keyword

blood pressure; interarm difference; subclavian artery stenosis

MeSH Terms

American Heart Association
Anesthesia
Arm
Blood Pressure
Ephedrine
Humans
Peripheral Vascular Diseases
Subclavian Artery
Subclavian Steal Syndrome
Transplants
Ephedrine