Propranolol Use for a Psychiatric Indication Contributing to Intra-anesthetic Hypotension: A Case Report

Intra-operative hypotension is generally responsive to decreasing anesthetic depth and/or intravenous fluid boluses. We present a 20-year-old male with multiple refractory intra-anesthetic hypotensive episodes, determined to have multifactorial etiology. Using propranolol to treat anxiety and Asperger’s syndrome, an indication likely to increase due to recent research efforts, was identified as a key contributing factor. There are no published recommendations regarding the peri-operative management of beta-blocker therapy prescribed for non-cardiac indications, and anesthesiologists should consider preoperative discontinuation because there is no elevated risk of major adverse cardiac events.