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[Preanesthetic assessment of a patient with giant negative T waves on ECG following subarachnoid hemorrhage].

Giant negative T waves on ECG are associated with intracranial hemorrhage such as subarachnoid hemorrhage, ischemic heart disease such as subendocardial infarction, myocardial disease and others. They embarrass us in anesthetic management of urgent neurosurgical patients because of the requirement of making differential diagnosis among these diseases accompanying the ECG abnormality. An 80 year old woman undergoing radical clipping for cerebral artery aneurysm showed giant negative T waves on ECG. Although the ECG taken on admission to the hospital had been normal, huge giant negative T waves of 2 mV and QTc prolongation were detected on arrival in the operating room. Therefore, her cardiac function was evaluated by echocardiography to rule out subendocardial infarction. The echocardiogram revealed that wall motion of the left ventricle was mildly depressed, but her cardiac function was well maintained since the cardiac output was 4.1 l.min-1 and the ejection fraction was 59%. We thought that giant negative T waves were caused by subarachnoid hemorrhage and decided to perform anesthesia and surgery. Circulation during anesthesia and surgery was stable except a transient decrease in blood pressure due to massive hemorrhage during rupture of the aneurysm. We conclude that preanesthetic assessment of cardiac function by echocardiography is useful for anesthetic management of patients with giant negative T waves on ECG undergoing urgent radical operation for cerebral aneurysm.