Work

Anesthetic management of life-threatening hemorrhagic shock in a patient with Wellens' syndrome: A case report

Year: 2026

Type: article

Abstract: Wellens' syndrome, characterized by pathognomonic precordial T-wave inversions (V2–V4) signifying critical proximal left anterior descending (LAD) coronary artery stenosis, represents a high-risk form of unstable angina requiring urgent revascularization. We detail the challenging anesthetic management of a 50-year-old male who presented with hemorrhagic shock secondary to a splenic laceration following blunt abdominal trauma. Wellens' syndrome was concurrently diagnosed on the admission electrocardiogram. The critical management decision prioritized emergency splenectomy to control active, life-threatening hemorrhage over immediate coronary intervention. Anesthetic care focused on maintaining meticulous hemodynamic stability, optimizing the myocardial oxygen supply-demand balance, and minimizing cardiovascular depression during a modified rapid sequence induction utilizing etomidate and fentanyl. The patient successfully underwent splenectomy under general anesthesia, followed by urgent percutaneous coronary intervention (PCI) on postoperative day 2. Ultimately, this case demonstrates that navigating the high-stakes trade-off between fatal exsanguination and impending myocardial infarction requires a decisive hierarchy of clinical interventions and a tailored anesthetic strategy to balance these two competing, life-threatening emergencies.

Source: JCA advances.

DOI: 10.1016/j.jcadva.2026.100205

Authors: Min Joo Shin, Gi Yong Yoon, Jin Huh

Institutions: Kangwon National University, Kangwon National University Hospital

Language: English

Topic: Anesthesia and Sedative Agents

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,200