persistent hypotension with relative bradycardia after surgery; an unusual case of preventable hypothermic shock

Aims: postoperative hypotension is a common and potentially life-threatening complication, typically accompanied by compensatory tachycardia. the occurrence of persistent hypotension with relative bradycardia is unusual and suggests distinct mechanisms, such as conduction abnormalities, medication effects, electrolyte disturbances, or hypothermia. prompt recognition of the underlying cause is essential to avoid adverse outcomes. this study reported an unusual case of preventable hypothermic shock.patients & methods: this study described a 54-year-old woman who developed persistent hypotension (70/40mmhg) with relative bradycardia (55bpm) following a total abdominal hysterectomy under general anesthesia. laboratory workup, electrocardiography, and echocardiography were unremarkable. despite the administration of 2 liters of intravenous fluids, no improvement was observed. her core temperature was 35.3°c. upon reassessment, a wet surgical drape was found underneath her back, causing hypothermia. removal of the drape and active rewarming restored hemodynamic stability (blood pressure 110/70mmhg, heart rate 75bpm, temperature 36.3°c), which was maintained throughout her hospitalization.findings: hypothermia can impair cardiovascular stability through bradycardia, reduced myocardial contractility, vasodilation, and diminished catecholamine responsiveness. in this case, inadvertent perioperative hypothermia due to a wet drape was the sole cause of refractory hypotension with relative bradycardia. this highlights the importance of considering environmental and physical factors in the differential diagnosis when standard investigations are inconclusive.conclusion: persistent hypotension with relative bradycardia in the postoperative setting should raise suspicion for hypothermia after excluding common causes.