AN UNUSUAL CAUSE OF ACUTE CHEST PAIN DURING EPIDURAL-ANESTHESIA

Background and Objectives. Selective sympathetic denervation during ep idural anesthesia results in a small, active gut. These changes can al so result in selective activity in one segment of the gut that is abse nt in other segments. Case Report. A 61-year-old male was scheduled fo r bilateral total knee replacement during epidural anesthesia. Followi ng onset of the epidural block, he experienced severe left-sided chest pain. Surgery was canceled. A portable chest radiograph revealed a wi dened mediastinum, and he underwent angiography to rule out a dissecti ng thoracic aortic aneurysm. The left subclavian artery could not be v isualized, and an MRI was obtained, which was normal. After his return to the intensive care unit, he had a large bowel movement and his che st pain resolved. Conclusion. Selective activity of the gastrointestin al tract during the onset of epidural anesthesia created a visceral pa in, which effectively simulated pain with a cardiovascular origin.