Disfunción tiroidea inducida por amiodarona en pacientes portadores de arritmias / Thyroid dysfunction induced by Amiodarone in patient with arrhythmias

Evaluar la presencia de disfunción tiroidea en pacientes con arritmias cardíacas tratados con Amiodarona (AMD) Métodos: se realizó el estudio en 24 pacientes que presentaron arritmias supraventriculares o ventriculares tratados con AMD, atendidos en el Servicio de Medicina Interna de la Ciudad Hospitalaria "Dr. Enrique Tejera" durante el período julio 2015 ­ abril 2016. Se les determinaron T3L, T4L y TSH a manera de tamizaje previo a la administración de AMD y fueron citados y divididos en 3 grupos de 3, 6 y 12 meses de tratmiento de AMD con determinación del perfil tiroideo en la consulta. Resultados: El hipotiroidismo inducido por AMD (HIA) se presentó en 20,83% (n=5), siendo más frecuente en aquellos pacientes asculinos que tenían 3 meses de tratamiento y que recibían una dosis de 1400 mg/semanal. La tirotoxicosis inducida por AMD (TIA) se presentó en 8,33% (n=2) ambos masculinos con dosis de 1400 mg/semanal. No se encontró asociación entre HIA y TIA con el tiempo, dosis, grupo etario ni género (P>0,05). T3L, T4L y TSH registraron el mayor y menor promedio a los 12 y 3 meses (P < 0,05); 12 y 6 meses; 3 y 12 meses respectivamente. Conclusión: La frecuencia de HIA fue de 20,83 % y TIA de 8,33 %. No hubo asociación estadísticamente significativa entre la HIA o TIA con la duración de consumo, dosis, grupo etario ni género. La TSH presentó el mayor promedio a los 3 meses, la T3L y T4L a los 12 meses (AU)

to evaluate the presence of thyroid dysfunction in patients with cardiac arrhythmia who were treated with Amiodarone (AMD). Methods: the study was done in 24 patients who were treated for supraventricular or ventricular arrhythmia at the Department of Internal Medicine of Hospital "Dr. Enrique Tejera" in Valencia, Venezuela from July 2015 to April 2016. FT3, FT4 and TSH were measured to the administration of AMD. The patients were divided in 3 groups according to time of use of the drug as follows: 3, 6 and 12 months, and their thyroid function was measured at each of these periods. Results: 20.83 % (n=5) presented Amiodarone induced hypothyroidism (AIH), which was more frequent in males at 3 months of treatment and who received 1400 mg weekly. Amiodarone induced thyrotoxicosis (AIT) was found in 8.33% (n=2) also in male patients using 1400mg weekly. There was no association between AIH or AIT and duration, dose of AMD, age or gender. (p>0.05) FT3, FT4 and TSH registered their higher and lower averages on 12 and 3 months (P < 0,05); 12 and 6 months; 3 and 12 months respectively. Conclusion: AIH's frequency was 20.83 % and 8.33% for AIT. There was no statistically significant association between AIH or AIT and duration, dose of AMD, age or gender TSH average measure was higher at 3 months and the FT3 and FT4 at 12 months(AU)

Transient Complete Left Bundle Branch Block during Emergency Laparotomy under General Anesthesia / 대한마취과학회지

Transient Complete left bundle branch block (CLBBB) is defined as an intraventricular conduction defect that subsequently returns, if only temporarily, to normal conduction. CLBBB is usually permanent and associated with a structurally abnormal heart, especially the heart with artherosclerotic, hypertensive, or valvular disease. However, CLBBB may appear transiently and intermittently during anesthesia, although it is uncommon.It may be related to the changes in heart rate or blood pressure without any heart disease. Also, transient CLBBB may develop during anesthesia in the absence of associated tachycardia or hypertension. We report a case of transient CLBBB which developed without apparent associated hypertension or tachycardia during general endotracheal anesthesia.

Left Stellate Ganglion Block Prior to Induction of Anesthesia for Surgical Sympathectomy in a Patient with Long QT Syndrome / 대한마취과학회지

Long QT Syndrome is characterized by syncope and fatal ventricular arrhythmia. Monotherapy with beta blockers is the first-line therapy. In patients with recurrent syncope despite therapy with beta blockers, combinations of the following modalities of treatment may be considered: pacemakers, left cervicothoracic sympathectomy, and implantable cardioverter defibrillators. Recently, we anesthetized a patient with Long QT Syndrome who underwent thoracoscopic left upper ganglionectomy for recurrent episodes of syncope and ventricular arrhythmia despite aggressive use of propranolol. Because of the increased risk of developing fatal ventricular arrhythmias during anesthesia and surgery, we performed a left stellate ganglion block prior to induction of anesthesia to prevent the ventricular arrhythmia that may be triggered by stimulation of the sympathetic nervous system and to assess the effect of surgical ganglionectomy on the QT interval. Following the block, the QT interval was shortened, and anesthesia and surgery was uneventful though anesthetic induction caused serious sympathetic responses. We recommend a left stellate ganglion block prior to induction of anesthesia in patients with Long QT Syndrome resistant to beta blocker to prevent fatal arrhythmia and to predict the efficacy of the surgical sympathectomy on the QT interval.

Value of Cardiac MR Imaging for the Diagnosis of Arrhythmogenic Right Ventricular Dysplasia:Comparison of Clinical and MR Imaging Diagnostic Grades

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.

Value of Cardiac MR Imaging for the Diagnosis of Arrhythmogenic Right Ventricular Dysplasia:Comparison of Clinical and MR Imaging Diagnostic Grades

PURPOSE: To evaluate the usefulness of cardiac MRI in the diagnosis of clinically suspected arrhythmogenic right ventricular dysplasia (ARVD). MATERIALS AND METHODS: Between February 1991 and January 1999, 15 patients [M:F=13:2, aged 2 -60 (mean, 37 -7) years] with clinically suspected ventricular arrhythmia due to unknown causes underwent MR imaging. Using a CP body array coil and the single slice breath hold technique, ECG-gated T1-weighted images were obtained. In all patients, these were acquired transaxially from the diaphragm to the aortic arch and along the true short and long axis, and in two, coronal images were obtained. On the basis of clinical and MRI diagnostic criteria, ARVD was classified as one of four types. The significance of differences in diagnostic grades between clinical and MRI criteria was determined using Wilcoxon's signed rank test. RESULTS: According to both clinical and MRI criteria, it was highly probable that three of the 15 patients had ARVD. In eleven, both sets of criteria indicated the same diagnostic grade. Wilcoxon's signed rank test indicated no significant differences in diagnostic grades between clinical and MRI criteria (p > 0.05). CONCLUSION: For the diagnosis or exclusion of ARVD, MR imaging is a useful modality.

Unexpected Intermittent Preexcitation Syndrome (WPW Type) in Patient with Ventricular Parasystole during General Anesthesia: A case report / 대한마취과학회지

We report a case in which WPW (Wolff-Parkinson-White)-type preexcitation syndrome arose unexpectedly immediately after induction of general anesthesia on a 25-yr-old man who had another rare cardiac arrhythmia, parasystole. His preoperative ECG showed ventricular bigeminy and a delta wave was observed after induction of anesthesia with fentanyl, midazolam and propofol. Anesthesia was maintained with propofol, fentanyl and nitrous oxide. The intraoperative ECG showed varying and temporary responsiveness to drugs such as atropine, lidocaine and ephedrine. After we started to infuse the dobutamine, the delta wave, ventricular bigeminy disappeared on the intraoperative ECG. We should consider the influence of anesthesia-related agents on arrhythmia, and aim to prevent and manage tachyarrhythmias caused by this syndrome.

Repeated Ventricular Fibrillation during Emergence of General Anesthesia Caused by Variant Angina: A case report / 대한마취과학회지

Variant angina is characterized by recurrent attacks of chest pain occurring at rest and associated with ST segment elevation on EKG and its cause is now established to be spasm of a major coronary artery. In patient with variant angina coronary artery spasm can be provoked by a number of physiologic maneuver, hyperventilation and pharmacologic agents such as ergonovine, histamine, epinephrine, methacholine, and dopamine. This may be associated with acute myocardial infarction and severe cardiac arrhythmia including ventricular tachycardia and fibrillation as well as sudden death. We present a case of repeated ventricular fibrillation that occured in a 60 years old male patient at the emergence from anesthesia. The cause of venticullar fibrillation was strongly suspected of variant angina on the basis of EKG findings. The patient was successfully resucitated by intensive treatment and nitroglycerine infusion. The patient recovered uneventfully and diagnosed variant angina by ergonovine test performed after recovery.

The Effect of Magnesium Pretreatment on Serum Potassium Concentration and Hemodynamic State in Rabbits during Continuous Regular Insulin(RI) Infusion / 대한마취과학회지

Background: Insulin is known to act as second effector that provides potassium transfer from extracellular fluid to intracellular fluid, thus causing hypokalemia and arrythmia. We evaluated the effect of magnesium sulfate treatment on hemodynamics and serum potassium concentration, induced by continuous infusion of regular insulin solution in rabbits. Method: Twenty-four rabbits were divided into four groups for the experiment. Group I was given intravenouse injection of 5 ml of normal saline and continuous dripping of 7.5 U of RI. Group II was pretreated with 30 mg/kg of magnesium sulfate, followed by continuous dripping of 7.5 U of RI. Group III was given 5 ml of normal saline and 15 U of RI. And Group IV was administered 15 U of RI after 30 mg/kg of magnesium sulfate pretreatment. Venouse blood sampling was done before pretreatment, and after 5, 30, 60 and 120 minutes respectively. Heart rate and arterial blood pressure were taken at the same intervals. Result: 1) There was no significant change in serum potassium concentration in groups injected with 7.5 units of RI respectively (groups I and II), regardless of magnesium pretreatment. But in groups injected with 15 units of RI, the group that was not pretreated with magnesium (Groups III) showed a decrease in serum potassium concentration from 3.39+/-0.57 Eq/L to 2.29+/-0.71 mEq/L, while the concentration in the pretreated group (Group IV) decreased more significantly from 3.35+/-0.50 mEq/L to 1.81+/-0.41 mEq/L. 2) Pulse rate did not change significantly in groups that received continuous infusion of 7.5 units of RI (groups I and II) regardless of magnesium pretreatment, but increased significantly in groups injected with 15 units of RI (groups III and IV), pretreated or not. The pretreated group (group IV) had a more significant rise in pulse rate compared with the group that was not pretreated (group III). 3) In all of the groups, those pretreated with magnesium (groups II and IV) and those not pretreated (groups I and III), there was no significant change in systolic and diastolic blood pressures. Nor was arrhythmia detected. Conclusion: The above results indicate that while magnesium sulfate pretreatment at 30 mg/kg with insulin infusion affects serum potassium concentration, has an antiarrhythmic effect, and may induce tachycardia, it does not have any significant effect on blood pressure.

Atrial Fibrillation during Repair of Esophageal Hiatal Hernia: A case report / 대한마취과학회지

Postoperative atrial arrhythmia after thoracotomy is relatively common, with a reported incidence ranging from 8% to 30%. These arrhythmias may cause hypotension, congestive heart failure and lengthen the period of postoperative hospitalization. The most important precipitating factor is atrial dilation and identified risk factor is an advanced age of the patient. The effect of various prophylactic regimens to reduce atrial arrhythmias is controversial. We report a case of postoperative atrial fibrillation in a 73 year-old female patient undergoing repair of esophageal hiatal hernia.

Severe Bradycardia and Hypotension degrees Ccurred during Positional Change in an Acute Cervical Spinal Cord Injury Patient under General Anesthesia / 대한마취과학회지

Bradycardia is recognized as an acute complication of cervical cord injury. The etiology of such a phenomenon is believed to be due to an imbalance in the autonomic nervous system imposed on the heart by a cervical cord injury. The majority of the episodes of bradycardia degrees Ccurred either with tracheal suctioning or with changes in position. We experienced a case of severe bradycardia and hypotension when turning the patient with acute cervical spinal cord injury to the prone position, which was reversed by administration of intravenous atropine and ephedrine.

A Comparative Study of Arrhythmogenic Doses of Epinephrine during Sevoflurane or Halothane Anesthesia in the Dogs / 대한마취과학회지

BACKGROUND: Epinephrine used in surgery to provide hemostasis may elicit ventricular arrhythmias. A desirable anesthetic would not sensitize the myocardium to exogenously administered epinephrine. So the effect of sevoflurane, which was introduced to clinical anesthesia recently, on cardiac arrhythmias induced by the infusion of epinephrine was compared with those of halothane which was already known to epinephrine-induced arrhythmia in the 14 mongrel dogs. METHODS: The authors compared the arrhythmogenicity (three or more premature ventricular contractions, PVCs)of intravenously administered epinephrine in 14 mongrel dogs who were randomly assigned to receive sevoflurane (1.7 vol%) or halothane (0.75 vol%) anesthesia equipotently. The arrhythmogenic doses of epinephrine determined in this comparative study were expressed by both infusion rates of epinephrine during sevoflurane and halothane anesthesia. RESULTS: The mean values of the arrythmogenic infusion rates of epinephrine were 27.1 7.6 g/kg for sevoflurane and 2.7 0.8 g/kg for halothane. CONCLUSIONS: We concluded that the arrythmogenic doses of epinephrine during sevoflurane were significantly higher than those during halothane anesthesia.

Balanced Anesthesia in a Patient with Complete Left Bundle Branch Block: Case report / 대한마취과학회지

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.

Balanced Anesthesia in a Patient with Complete Left Bundle Branch Block: Case report / 대한마취과학회지

Local or general anesthesia is essential for safe operation. Patients in good preoperative condition are relatively to tolerable to the operation, but the patients in poor preoperative condition have the high mortality and morbidity during and after the operation. Therefore, we should choose the anesthetic agents and methods, which cause little effect to the patient's life. Among the intraventricular blocks, bundle branch is the most common type, and left bundle branch block may progress to a more serious condition of complete heart block. Optimal anesthetic management of patients with cardiovascular disease requires a thorough knowledge of normal cardiac physiology, the circulatory effects of the various anesthetic agents, and the pathophysiology and treatment of these diseases. The authors successfully performed balanced anesthesia in operation of a 63 year old female patient who showed complete left bundle branch block pattern in a preoperative electrocardiographic tracing without any subjective symptoms.