Our case differs from previous cases in that this patient underwent general anesthesia alone, without epidural blockade. A yr-old man kg, cm was scheduled to undergo repair of the mitral valve. An echocardiogram revealed severe mitral regurgitation with left ventricular dilation diastolic dimension of 6. The preoperative electrocardiogram was normal. He had been treated for 2 yr with clomipramine, mg at bedtime, for pruritus, and he continued this treatment the night before surgery.

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