1/6. 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) |
2/6. Methaemoglobinaemia after cardiac catheterisation: a rare cause of cyanosis.Two young women had unexpected cyanosis a few hours after cardiac catheterisation for electrophysiological investigation. The first patient had atrioventricular septal defect, had undergone repeated surgical interventions, and was referred because of atrial flutter. The second patient had ablation of an accessory pathway in wolff-parkinson-white syndrome. Local anaesthesia was performed with 40 ml prilocaine 2%. cyanosis with oxygen saturation of 85% developed in both patients a few hours after the electrophysiological investigation. The patients were transferred to the intensive care unit and for the first patient a considerable diagnostic effort was made to rule out morphological complication. Finally methaemoglobinaemia of 16.7% and 33.4%, respectively, was found. cyanosis resolved within 24 hours and did not reappear. Underlying glucose-6-phosphate dehydrogenase deficiency and erythrocyte-methaemoglobin reductase deficiency were ruled out. physicians should be aware of this rare side effect of local anaesthetics in patients with unexpected cyanosis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/6. Anaesthesia for caesarean section in a patient with wolff-parkinson-white syndrome.The anaesthetic management is described of a patient with wolff-parkinson-white syndrome who had to undergo caesarean section due to failed induction of labour. Spinal anaesthesia with hyperbaric nupercaine was given. The main problem encountered during anaesthetic management was repeated attacks of supraventricular tachycardia which were primarily due to anxiety or occurred during pharmacological intervention with oxytocics.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/6. Modification of a left-sided accessory atrioventricular pathway by radiofrequency current using a bipolar epicardial-endocardial electrode configuration.Transcatheter ablation of a left posterolateral free wall accessory atrioventricular pathway using radiofrequency current and a bipolar epicardial-endocardial electrode configuration was attempted in a 19-year-old woman. The patient had suffered from recurrent syncope due to atrial fibrillation with rapid conduction to the ventricles. Following applications of radiofrequency current between one electrode in the coronary sinus and another in the left ventricle placed high against the mitral annulus, the anterograde effective refractory period was increased from less than 205 ms to a lasting value of 460 ms. Radiofrequency application could be performed without general anaesthesia and caused no side-effects.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
5/6. wolff-parkinson-white syndrome. Termination of paroxysmal supraventricular tachycardia with phenylephrine.A patient with wolff-parkinson-white syndrome, susceptible to tachydysrhythmias , presented for eye surgery under general anaesthesia. He developed a supraventricular tachycardia refractory to a variety of treatments. phenylephrine consistently abolished the dysrhythmia, probably by acting directly to stimulate the arterial baroreceptors and hence vagal output. Vasopressor therapy should be considered in wolff-parkinson-white syndrome tachyarrhythmias, when circumstances permit.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
6/6. Concealed wolff-parkinson-white syndrome detected during spinal anaesthesia.We report a case of concealed wolff-parkinson-white syndrome detected for the first time during spinal anaesthesia in an adult male. Episodes of tachyarrhythmia with a heart rate of approximately 115 beat.min-1, wide QRS complexes and negative T waves which lasted 30-60 s, but were unassociated with hypotension, occurred three times after spinal anaesthesia. Postoperative Holter ECG monitoring showed the frequent occurrence of supraventricular premature contractions and paroxysmal supraventricular tachycardias with the same electrophysiological characteristics as those noted during spinal anaesthesia. The patient was diagnosed as having concealed wolff-parkinson-white syndrome. Since this condition is asymptomatic and undetectable by routine pre-operative screening it is likely that other unsuspected cases will arise. When episodes of tachyarrhythmia occur unexpectedly during anaesthesia, as was the case in this patient, postoperative examination including Holter ECG monitoring will be necessary to determine the nature and severity of the tachyarrhythmia.- - - - - - - - - - ranking = 8keywords = anaesthesia (Clic here for more details about this article) |