1/5. Development of rapid atrial fibrillation with a wide QRS complex after neostigmine in a patient with intermittent wolff-parkinson-white syndrome.We report the case of a 67-yr-old man with intermittent Wolff-Parkinson-White (WPW) syndrome in whom neostigmine produced life-threatening tachyarrhythmias. The patient was scheduled for microsurgery for a laryngeal tumour. When he arrived in the operating room, the electrocardiogram showed normal sinus rhythm with a rate of 82 beat min-1 and a narrow QRS complex which remained normal throughout the operative period. On emergence from anaesthesia, the sinus rhythm (87 beat min-1) changed to atrial fibrillation with a rate of 80-120 beat min-1 and a normal QRS complex. We did not treat the atrial fibrillation because the patient was haemodynamically stable. neostigmine 1 mg without atropine was then administered to antagonize residual neuromuscular block produced by vecuronium. Two minutes later, the narrow QRS complexes changed to a wide QRS complex tachycardia with a rate of 110-180 beat min-1, which was diagnosed as rapid atrial fibrillation. As the patient was hypotensive, two synchronized DC cardioversions of 100 J and 200 J were given, which restored sinus rhythm. No electrophysiological studies of anticholinesterase drugs have been performed in patients with WPW syndrome. We discuss the use of these drugs in this condition.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Spinal subdural haematoma: how relevant is the INR?STUDY DESIGN: Case report. OBJECTIVE: To report a rare cause of spinal cord compression. SETTING: University Hospital, wales, UK. CASE REPORT: A 67-year-old gentleman on oral anticoagulation for atrial fibrillation presented with a 4-h history of progressive loss of sensation and weakness in both legs; there was no history of trauma. On examination, he had a flaccid paraplegia with altered sensation in the L1,2,3 dermatomes and complete anaesthesia in the L4,5 distribution. knee and ankle jerk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anterior canal between T10 and L3. The patient had an uneventful postoperative course generally, but at 1 week there was no neurological recovery. CONCLUSION: This case highlights that anticoagulation even when well controlled is not without risk. This is particularly of concern as the number of patients receiving long-term anticoagulation therapy has doubled between 1993 and 1998.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/5. Resumption of sinus rhythm during general anaesthesia in an elderly patient with chronic atrial fibrillation: a case report.Conversion to sinus rhythm is a rare event in a patient with chronic atrial fibrillation. There are no reports in the literature of this happening during general anaesthesia. This case report presents such a case and discusses the possible aetiology.- - - - - - - - - - ranking = 5keywords = anaesthesia (Clic here for more details about this article) |
4/5. A case of tachydysrhythmia. Refractory to propranolol and responsive to neostigmine.A case of atrial fibrillation, with a fast ventricular response, which developed under enflurane anaesthesia is described in a patient previously treated with digitalis and propranolol. The intravenous administration of propranolol was ineffective whereas that of neostigmine and atropine, 2 hours later, was successful and reduced the ventricular rate to normal values.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/5. Hypomagnesaemia, cardiac arrhythmias and orthotopic liver transplantation.Two patients who underwent orthotopic liver transplantation and developed peroperative cardiac arrhythmias are presented. In one, the arrhythmias were refractory to treatment with anti-arrhythmic drug therapy until serum magnesium levels were restored to normal. The other patient had a low pre-operative serum magnesium level and developed atrial fibrillation on induction of, and during, anaesthesia. patients undergoing orthotopic liver transplantation may be a group especially predisposed to hypomagnesaemia. The importance of monitoring serum magnesium levels in such patients who develop peroperative cardiac arrhythmias is emphasised.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |