1/11. heart block following propofol in a child.We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/11. Wenckebach type heart block following spinal anaesthesia for caesarean section.A case is described of complete heart block during spinal anaesthesia for Caesarean section in a fit 23 yr-old-woman. This developed shortly after the institution of the block, with the height of the block below T5 and in the absence of hypotension. The patient was resuscitated successfully with vagolytic and alpha-agonist drugs. A Wenckebach block persisted for a short period postoperatively. The importance of instituting monitoring before the beginning of anaesthesia and the immediate availability of atropine and alpha-agonists before the initiation of spinal anaesthesia is stressed.- - - - - - - - - - ranking = 3.5keywords = anaesthesia (Clic here for more details about this article) |
3/11. A patient with congenital complete heart block undergoing multiple exposures to general anaesthesia.We present a patient with congenital complete heart block who underwent multiple anaesthetic exposures for eye examination and bilateral cataract surgery. The diagnosis was made during the first general anaesthetic. Various complications encountered during the multiple exposures are discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
4/11. Anaesthetic management in a neonate with congenital complete heart block.We present the case of a neonate undergoing surgery on the first day of life for the installation of a permanent pacemaker because of the existence of congenital complete heart block (CCHB) with a basal heart rate of 43 b.min(-1) and minimal elevation after initiating an isoproterenol perfusion. The intervention was under general anaesthesia with laryngeal mask airway (LMA) and spontaneous ventilation. The principal anaesthetic goals were to assure adequate anaesthesia, with haemodynamic and respiratory stability, to maintain the best possible heart rate and to avoid postoperative respiratory depression or apnoea.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/11. Progression of first degree heart block to high-grade second degree block during spinal anaesthesia.A case is presented in which a patient with pre-existing first degree heart block developed high-grade second degree heart block during spinal anaesthesia. Progression of the block was associated with blockade of cardiac sympathetic neurons induced by spinal anaesthesia. This suggests that patients with pre-existing heart block may be at increased risk for development of higher grade block during spinal anaesthesia.- - - - - - - - - - ranking = 3.5keywords = anaesthesia (Clic here for more details about this article) |
6/11. Anaesthetic management of congenital heart block and persistent ductus arteriosus in an infant.ketamine hydrochloride, pancuronium bromide and 100% oxygen were used during general anaesthesia for a left antero-lateral thoracotomy, insertion of a permanent cardiac pace-maker and ligation of a persistent ductus arteriosus in a three-month-old female infant, who was also in congestive cardiac failure. To the best of our knowledge, this is the first reported case of successful anaesthetic management for insertion of cardiac pace-maker and ligation of persistent ductus arteriosus under general anaesthesia in a Nigerian infant. The successful out-come of our anaesthetic technique encourages us to recommend the procedure for the anaesthetic management of similar complex cardiac abnormalities.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
7/11. heart block following propofol: a case report.We report two cases of ventricular arrest with persisting atrial activity in association with propofol anaesthesia. In both cases, anticholinergic agents corrected the arrhythmia. It is recommended that anticholinergic drugs be given routinely when propofol is used in association with vagal stimulants.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
8/11. Complete heart block during anaesthesia in a patient with sarcoidosis.An apparently fit young man with sarcoidosis developed complete heart block during an emergency mastoidectomy. A temporary transvenous pacemaker was inserted, but permanent pacing was required in the postoperative period. The clinical and pathological features of cardiac sarcoidosis are described; complete heart block is the commonest presentation of cardiac involvement. The role of anaesthesia as the precipitating factor in this case is discussed.- - - - - - - - - - ranking = 2.5keywords = anaesthesia (Clic here for more details about this article) |
9/11. Anaesthesia and amiodarone.Two recent reports support and one report disputes the existence of dangerous interactions between the new benzofuran antiarrhythmic amiodarone and the anaesthetic state. We have reviewed our experience with 17 anaesthetics administered to 16 patients taking amiodarone. Haemodynamics and serum amiodarone levels were evaluated where available. Twelve cases involved cardio-pulmonary bypass; of these, three patients died. There were no deaths in the non-cardio-pulmonary bypass group. The charts of 30 patients with poor left ventricular function, who were not receiving amiodarone but who were undergoing coronary artery bypass surgery, were reviewed to establish a comparison group. Interactions were manifested in three forms: nodal rhythm and/or complete heart block developed in ten of 15 patients (one patient had a preoperative pacemaker inserted for the sick sinus syndrome), poor cardiac output requiring intra-aortic balloon pump augmentation developed in six of 12 cardio-pulmonary bypass patients, or, a state of alpha adrenergic blockade leading to a low systemic vascular resistance despite alpha agonist therapy developed in two of 16 patients. We conclude that dangerous, fatal interactions may occur in patients taking amiodarone who undergo general anaesthesia with cardio-pulmonary bypass. Anaesthesia for non-cardiac surgery may be associated with haemodynamically significant bradyarrhythmias. We recommend aggressive invasive monitoring, including pulmonary artery catheterization and consideration of an atrio-ventricular pacemaker in high risk patients.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
10/11. Peri-operative management and administration of anaesthesia in children with congenital complete heart block. A case report and review.The clinical presentation and natural history of congenital complete heart block (CHB) differ from those of acquired third-degree heart block. Although perioperative prophylactic cardiac pacing is considered mandatory in patients with acquired CHB, it is not usually necessary in children with asymptomatic congenital heart block. The anaesthetist should be able to identify which patients require temporary perioperative pacing, and should modify his anaesthetic technique appropriately for patients who do not. An 8-year-old patient with congenital CHB who required emergency surgery for acute appendicitis is presented and the anaesthetic management, including the indications for pacing, is discussed.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
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