Fentanyl/Propofol/rocuronium bromide
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Fentanyl/Propofol/rocuronium bromide Polymorphic ventricular tachycardia, acquired long QT syndrome and atypical stress-induced cardiomyopathy: case report
A 55-year-old woman developed polymorphic ventricular tachycardia, acquired long QT syndrome from atypical stress-induced cardiomyopathy during anaesthetic induction with propofol, fentanyl and rocuronium bromide. The woman, who had thyroid cancer, was scheduled for elective surgical resection of right acetabular solitary metastasis and cemented total hip replacement. She achieved sedation and general anaesthesia with standard doses of fentanyl, propofol and rocuronium bromide [dosage and routes not stated]. During anaesthesia induction, she developed broad complex tachycardia, consistent with ventricular tachycardia (VT). During monitoring, the polymorphic VT was observed with hemodynamic manifestation, which was successfully treated with metoprolol. Surgery was terminated. The woman was treated with fluid resuscitation. She was admitted to the cardiac unit with pulmonary oedema, which responded to furosemide. Lab tests showed high-sensitivity troponin-T of 580 ng/L. She was treated with aspirin, clopidogrel, bisoprolol and ramipril. Invasive coronary angiography showed unobstructed coronaries. After resolution of VT, ECG showed Twave inversion and prolonged corrected QT interval. Echocardiography showed subtle hypokinesis in the mid-inferoseptum/inferior wall. She was diagnosed with multifactorial acquired long QT syndrome secondary to atypical variant stress-induced cardiomyopathy. Her condition resolved except persistent T-wave inversion prior to discharge. She was discharged on bisoprolol and ramipril. She was also implanted a loop recorder, which detected no arrhythmias till last follow-up. Alfarih M, et al. An unusual cause of polymorphic ventricular tachycardia: Acquired long QT syndrome from atypical variant of stress-induced cardiomyopathy. SAGE Open 803502351 Medical Case Reports 8: 01 Jan 2020. Available from: URL: http://doi.org/10.1177/2050313X20944307
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Reactions 26 Sep 2020 No. 1823
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