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Recent APSF case reports describe profound intraoperative hypotension and bradycardia in patients with recent recreational sympathomimetic exposure, occurring even in initially stable or hypertensive presentations. Cardiovascular collapse may emerge ~20 minutes after induction as catecholamine effects fluctuate or deplete. Features: • Unpredictable transitions from sympathetic excess to cardiovascular depression • Reduced responsiveness to indirect vasopressors. Direct-acting agents may be more
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