Anaesthetics
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Anaesthetics Heart arrest in a patient with sick sinus syndrome: case report A 40-year-old woman with sick sinus syndrome developed heart arrest during general anaesthesia with propofol, fentanyl and vecuronium bromide, as well as epidural anaesthesia with ropivacaine. The woman, who had previously undergone both local and general anaesthesia without complications, presented for abdominal hysterectomy due to uterine leiomyoma. Prior to the procedure, ECG showed normal sinus rhythm at a rate of 70 beats/min and, in the operating room, her baseline HR was 65 beats/min. Atropine was administered and her HR increased by 15%. Following this, general anaesthesia was induced with fentanyl 0.1mg, vecuronium bromide 8mg and propofol [dosage not stated], and maintained with target controlled infusion of fentanyl and propofol boluses [dosages not clearly stated]; the effect-site propofol concentration was set at 3 µg/mL and, prior to skin incision, she had received a total dose of 0.15mg of IV fentanyl. Prior to surgery, she had also undergone epidural anaesthesia with 0.75% ropivacaine 8mL [dosage not clearly stated]. During peritoneal traction, she developed severe bradycardia, followed by sinus arrest [time to reaction onset not clearly stated]. The woman received IV atropine and underwent external cardiac massage and, within 40 seconds, her HR recovered to 70 beats/min. The operation was resumed. However, two further episodes of bradycardia (HR of < 40 beats/min) occurred during the procedure; atropine was administered, which increased her HR by 20% each time. Following these episodes, the effect-site propofol concentration was decreased to 2.5 µg/mL and her HR remained at approximately 60 beats/min even after IV fentanyl boluses. The duration of anaesthesia was 3 hours and 57 minutes and, at the end of surgery, there was loss of cold sensation from T7 to L2. Postoperatively, a 24-hour Holter ECG revealed a sinus arrest, lasting for 6.6 seconds; this indicated silent sick sinus syndrome [patient outcome not clearly stated]. Author comment: "It is possible that the combination of all these intravenous anesthetics with high epidural anesthesia and surgical stimulation caused instability of the autonomic nervous system. As a result . . . the relatively vagotonic state made the silent sinus node dysfunction apparent, leading to long-lasting cardiac arrest." Ishida R, et al. Prolonged cardiac arrest unveiled silent sick sinus syndrome during general and epidural anesthesia. Journal of Anesthesia 21: 62-65, No. 1, Feb 2007 801070680 - Japan
0114-9954/10/1146-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 7 Apr 2007 No. 1146
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