1/4. Use of implantable cardioverter defibrillator and anti-arrhythmic agents in a parturient.We describe a case of a 36-yr-old patient who presented at 14 weeks gestation with multifocal dysrrhythmic episodes. Despite treatment with anti-arrythmic agents and an implantable cardioverter defibrillator (ICD) in situ, she continued to experience persistent dysrrhythmic episodes. She was delivered by Caesarean section at 34 weeks under general anaesthesia. We discuss some of the anaesthetic challenges of parturients with ICD devices.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. succinylcholine-induced cardiac arrest in children with undiagnosed myopathy.Two paediatric cases are reported in which unexpected, life-threatening arrhythmias occurred. Routine induction of general anaesthesia with thiopentone, 5 mg.kg-1, in one and with halothane in the other, and succinylcholine 1.25-1.5 mg.kg-1 i.v. was followed by the development of wide complex tachyarrhythmia with hypotension in the first case and asystole in the second case despite pre-treatment with atropine in both cases. The first patient was resuscitated with tracheal intubation, 100% oxygen, manual ventilation and intravenous lidocaine and bicarbonate. The second patient required intubation, manual ventilation, 12 min of CPR and i.v. calcium, epinephrine and bicarbonate, as well as DC counter shock. Neither patient received dantrolene. Early recovery in both patients was uneventful with no neurological sequelae. Subsequent investigations revealed the presence of a dystrophin-deficient muscular dystrophy, duchenne muscular dystrophy and Becker muscular dystrophy respectively, previously unsuspected, in both patients. The aetiology of the observed arrhythmias was presumably hyperkalaemia, secondary to succinylcholine-induced rhabdomyolysis. It is suggested that when faced with sudden, life-threatening arrhythmias following succinylcholine at induction of anaesthesia for paediatric patients, clinicians should include occult myopathy in the differential diagnosis, and thus consider the aggressive management of hyperkalaemia in addition to basic resuscitative efforts.- - - - - - - - - - ranking = 2keywords = anaesthesia (Clic here for more details about this article) |
3/4. acceleration of ventricular tachycardia following propofol in a patient with heterotopic cardiac transplant. Cardioversion of ventricular tachycardia in the native heart.A 52-year-old Caucasian male underwent heterotopic cardiac transplant and subsequently developed a ventricular tachycardia in his native heart. The arrhythmia was successfully treated by cardioversion, despite an increased rate associated with induction of anaesthesia with propofol. The method of synchronised cardioversion is described and a possible hypothesis for the acceleration of ventricular tachycardia following induction is discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. The management of anaesthesia for caesarean section in a patient with paroxysmal ventricular tachycardia.We describe the successful management of general anaesthesia for Caesarean section in a patient with poorly controlled paroxysmal ventricular tachycardia of pregnancy. The use of alfentanil before laryngoscopy and tracheal extubation ensured cardiostability without compromising maternal or fetal wellbeing. General anaesthesia allows prompt cardioversion. We believe that in the presence of a life-threatening unstable cardiac rhythm this consideration outweighs any theoretical advantage of regional blockade.- - - - - - - - - - ranking = 6keywords = anaesthesia (Clic here for more details about this article) |