Occurrence of paroxysmal supraventricular tachycardia accompanied by hemodynamic instability during anesthesia induction in patients with no previous history of arrhythmia

We report a rare case of paroxysmal supraventricular tachycardia arising suddenly during general anesthesia in a 76-year-old woman without a prior history of arrhythmia.She was scheduled for ovarian cancer surgery, presenting with Hepatitis C-related liver cirrhosis and hypertension, though her preoperative cardiac evaluation was unremarkable.Following induction, she rapidly developed tachycardia (exceeding 170 beats/min) and severe hypotension that was unresponsive to immediate vasopressor therapy.This life-threatening hemodynamic instability persisted for approximately 30 minutes in the operating room while the definitive diagnosis was delayed, after which the rhythm spontaneously reverted to normal.Upon transfer to the intensive care unit, the arrhythmia recurred, confirming paroxysmal supraventricular tachycardia.A normal rhythm was successfully restored with 6 mg of adenosine.Reoperation was successfully performed five days later under optimized antiarrhythmic therapy.This underscores the necessity of prompt diagnosis and definitive antiarrhythmic management to prevent life-threatening arrhythmias in the operating room.