• Aron Legler, Richard K Kim, and Nikhil Chawla.
• Department of Anesthesiology, Yale-New Haven Hospital. Electronic address: aron.legler@yale.edu.
• J Clin Anesth. 2016 Dec 1; 35: 493-496.

AbstractGlucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control. Nitroglycerin acted as a key agent to decrease the patient's blood pressure as well as a secondary relaxant of the sphincter of Oddi. The patient had no radiographic evidence of pheochromocytoma. As out-of-operating room and intraoperative uses of glucagon continue to increase, perioperative physicians should be aware of its potential hemodynamic effects even in healthy populations.Copyright © 2016 Elsevier Inc. All rights reserved.

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