Perioperative considerations in a patient with orthostatic intolerance syndrome.

ORTHOSTATIC intolerance syndrome is an unusual autonomic nervous system disorder characterized by episodic or postural tachycardia that occurs independent of alterations in arterial blood pressure and is associated with symptoms that include palpitations, tremulousness, light-headedness, fatigue, and syncope. Orthostatic intolerance syndrome is most often observed in young women and has also been described as postural orthostatic tachycardia syndrome, chronic orthostatic intolerance, or hyperadrenergic orthostatic tachycardia. This diverse terminology emphasizes the often confusing nature of this idiopathic disorder of primary autonomic failure. The medical treatment of orthostatic intolerance is controversial because the pathophysiology of the disease is complex. We describe the perioperative treatment of a patient with severe orthostatic intolerance syndrome who was scheduled for bilateral mastectomy.