title: [Therapeutic drug monitoring in perioperative period--management of atrial fibrillation in a patient with bradycardia due to relative overdose of digitalis].
abstract: We reported a 79 year old man with preoperative bradycardia due to relative overdose of digitalis prior to undergoing subtotal gastrectomy. The patient had received metildigoxin 0.2 mg.day-1 for atrial fibrillation preoperatively and severe bradycardia of 35-41 bpm was found on the preoperative ECG examination. Serum digoxin level was detected to be 1.91 ng.ml-1 on the day before surgery. We thought this serum level must be toxic for him, even though it was within normal limits for the majority. As we thought that his bradycardia had been caused by relative overdose of digitalis, he was withheld to receive metildigoxin on the day before surgery and thereafter. Heart rate on arrival at the operating theater was around 40-45 bpm, and therefore the patient was placed on a temporary pacemaker catheter before the anesthetic induction to prevent aggravating bradycardia during anesthesia and surgery. Heart rate during procedure was 50-70 bpm and hemodynamics was stable. Intravenous digoxin was restarted on the 2nd postoperative day because of decrease in serum digoxin level to 0.84 ng.ml-1 and it was converted to metildigoxin 0.1 mg.day-1 when he was permitted to take pills per os. Our experience demonstrates that perioperative therapeutic drug monitoring is clinically important for anesthesiologists to make proper pharmacological management of surgical patients who have received digitalis.
authors.affiliation: Department of Anesthesiology, Odate Municipal Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Murakawa
authors.forename: T
authors.initials: T
authors.lastname: Kubota
authors.forename: A
authors.initials: A
authors.lastname: Matsuki
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001919:Bradycardia / Q000139:chemically induced / Q000517:prevention & control*; D016903:Drug Monitoring; D062787:Drug Overdose; D005743:Gastrectomy; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008520:Medigoxin / Q000009:adverse effects* / Q000493:pharmacokinetics; D010138:Pacemaker, Artificial; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery
chemical_list: D000889:Anti-Arrhythmia Agents; D008520:Medigoxin