Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.
OBJECTIVE
Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane.


METHODS
We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia.


CONCLUSIONS
These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.
Department of Anaesthesia, Royal Group of Hospitals, Belfast, United Kingdom.
J M
JM
Murray
S R
SR
Luney
D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced; D002316:Cardiotonic Agents / Q000009:adverse effects*; D003327:Coronary Disease / Q000150:complications; D003402:Creatine Kinase / Q000097:blood; D000077335:Desflurane; D004280:Dobutamine / Q000009:adverse effects*; D004298:Dopamine / Q000009:adverse effects*; D004562:Electrocardiography / Q000187:drug effects; D017809:Fatal Outcome; D006258:Head and Neck Neoplasms / Q000601:surgery; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007431:Intraoperative Complications; D007527:Isoenzymes; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000201:enzymology / Q000209:etiology*; D011183:Postoperative Complications; D013610:Tachycardia / Q000139:chemically induced; D018879:Ventricular Premature Complexes / Q000139:chemically induced
D018685:Anesthetics, Inhalation; D002316:Cardiotonic Agents; D007527:Isoenzymes; D004280:Dobutamine; D000077335:Desflurane; D007530:Isoflurane; D003402:Creatine Kinase; D004298:Dopamine