A 76-year-old woman was scheduled to undergo distal gastrectomy and cholecystectomy. She had no history of illnesses including hypertension. During the induction of anesthesia, she developed hypertension just after intravenous administration of fentanyl 200 microg. The marked hypertension lasted for 30 min without any complaints and neurological symptoms, and gradually became normalized. We started the induction of anesthesia again without using fentanyl. For the maintenance of anesthesia, sevoflurane, nitrous oxide, and epidural anesthesia with intermittent administration of 0.75% ropivacaine were used. The operation was finished successfully without any complications. We consider intravenous small dose of fentanyl could be a cause of unexpected marked hypertension in this elderly patient.
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