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CARDIOVASCULAR ANESTHESIA

Shy-Drager Syndrome and Severe Unexplained Intraoperative Hypotension Responsive to Vasopressin

Ricardo Vallejo, MD^*, Gerard DeSouza, MD, and Jong Lee, MD^*

*Anesthesiology Department, Jackson Memorial Hospital/University of Miami; and Anesthesiology Service, Veterans Affairs Hospital, Miami, Florida

Address correspondence and reprint requests to Ricardo Vallejo, MD, Pain Management Fellow, Massachusetts General Hospital, Pain Center, 55 Fruit St., WACC 324, Boston, MA 02114. Address e-mail to rvallejo{at}partners.org

IMPLICATIONS: We describe the first case of Shy-Drager syndrome diagnosed on the basis of intraoperative hemodynamic changes. The initial hypertension in the supine position followed by severe hypotension after hydralazine administration, ultimately responsive to vasopressin, led to a diagnosis of Shy-Drager syndrome. We suggest that vasopressin may be the drug of choice in patients with Shy-Drager syndrome with refractory hypotension.