Hypotension with anesthesia in disulfiram-treated patients

Four cases of acute, serious hypotension (greater than 50 per cent decrease from baseline blood pressure) following tracheal intubation (2) or skin incision (2) in chronically alcoholic men receiving long-term (a year or more) disulfiram (Antabuse®) therapy are described. The patients ranged in age from 25 to 65 years, were all undergoing nonthoracic elective procedures, and manifested no other major systemic disease. In all cases, the observed hypotension was acute, followed stable periods of normotension, and closely followed stimulating events during general anesthesia, such as laryngoscopy, tracheal intubation, or incision of the skin. The anesthetic techniques in all cases included induction with thiopental, 3 mg/kg, succinylcholine, 1.0-1.5 mg/kg, for endotracheal intubation, and maintenance with either halothane or enflurane and nitrous oxide, 40-50 per cent, in oxygen. In all cases, the hypotension responded to discontinuance of the inhalational anesthesia and vigorous fluid therapy alone (1) or in combination with phenylephrine (2) or ephedrine (1).