Full flexion of the hips and knees in the supine position to treat an episode of acute hypotension and pulseless electrical activity in a patient with severe aortic stenosis

Abstract

This is a case report of a 77-year-old man with severe symptomatic aortic stenosis who underwent removal of an impacted ureteral stone under general anesthesia. During emergence from general anesthesia, his legs were lowered from lithotomy position, resulting in sudden hypotension with progression to pulseless electrical activity. The legs were raised and placed into full flexion of the hips and knees. This maneuver was temporally related to a return of spontaneous circulation and full recovery. Possible mechanisms for this effect are discussed.

KEYWORDS:

• Afterload
• aortic stenosis
• coronary perfusion pressure
• diastolic hypotension
• full flexion of knees and hips
• lithotomy position
• preload