RESUMO
A 45-year-old man was scheduled for laparoscopic cholecystectomy. He had hypertension controlled with beta-adrenergic, calcium channel and angiotensin II receptor blocking agents. Because he had complications of symptomatic cervical spondylosis and sleep apnea syndrome, we performed awake fiberoptic intubation with remifentanil at a dose of 0.05 microg x kg(-1) min(-1). After intubation and following administration of propofol and vecuronium, ECG unexpectedly changed to asystole. We administered atropine 1.5 mg and performed chest compressions, which successfully restored sinus rhythm within 10 seconds. However, no cardiac disease was detected by a cardiologist. The operation was scheduled a week later again. Anti-hypertensive agents were discontinued. A temporary pacing wire was inserted before surgery, and atropine 0.5 mg was administered before anesthetic induction with remifentanil. No cardiac event was noticed through the perioperative period. We suggest that even a low dose of remifentanil may cause asystole in patients taking beta-adrenergic and calcium channel blocking agents, and preemptive administration of atropine may be effective.
