[Ventricular fibrillation after administration of aclacinomycin emulsion into mesenteric lymph nodes in a patient anesthetized with enflurane, nitrous oxide and oxygen].
A 57-year-old man was given 40 mg of activated carbon aclacinomycin (ACM) emulsion into mesenteric lymph nodes during anesthesia with enflurane, nitrous oxide, oxygen and epidural anesthesia. He had no complications preoperatively. Immediately after the injection, his skin turned to red, and 5 minutes later, sinus tachycardia, R wave amplitude reduction, T wave amplitude elevation, QT prolongation and PVCs were noted, and then, ventricular fibrillation (Vf) occurred 15 minutes after the injection. We succeeded in electrical defibrillation within about 180 seconds. At that time, both arterial blood gas and electrocytes were normal. Serum ACM concentration was remarkably elevated 60 minutes after the administration, and remained high 22 hrs later. Postoperative course was uneventful and he was discharged on the 17th postoperative day. It has been said that ACM has relatively low cardiotoxicity compared with adriamycin because of rapid distribution and metabolism. However, it might cause cardiac complication such as ECG abnormality, heart failure, pericarditis, though the effects are transient and reversible. Therefore we should be ready for its rapid treatment. Coenzyme Q10 could counteract cardiotoxicity of ACM.
Kobayashi
Y
Y
Department of Anesthesiology, Kanagawa Cancer Center Hospital, Yokohama.
Usuda
Y
Y
Okutu
Y
Y
Okumura
F
F
Suzuki
H
H
Yoshida
G
G
Hayakawa
J
J
Shibata
T
T
D015250:Aclarubicin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D000769:Anesthesia, Inhalation; D004737:Enflurane; D006801:Humans; D007272:Injections, Intralymphatic; D008297:Male; D008643:Mesentery; D008875:Middle Aged; D009609:Nitrous Oxide; D010100:Oxygen; D014693:Ventricular Fibrillation / Q000139:chemically induced*
C011157:aclacinomycins; D015250:Aclarubicin; D004737:Enflurane; D009609:Nitrous Oxide; D010100:Oxygen