Acute fatal vasoplegia and asystole induced by intravenous amiodarone after cardiopulmonary bypass in a patient with preoperative cardiogenic shock.
Single dose intravenous amiodarone has been widely used and shown to be effective to treat supraventricular and ventricular arrhythemias in cardiac surgery. We, herein, report a 60-year-old female patient, sustaining cardiogenic shock in the course of percutaneous transluminal coronary angioplasty (PTCA) for unstable angina unrelieved by medication including nitroglycerin, succumbed to a life-saving emergent coronary artery bypass grafting (CABG) operation at the end of cardiopulmonary bypass (CPB) following a 180 mg bolus dose of amiodarone (3 mg/kg) directed at the ventricular arrhythmias, triggered by protamine and unresponsive to lidocaine treatment. Amiodaroneinduced asystole and vasoplegia were thought to be the causation of the failure of resuscitation. The causes of the development of these complications, the potential hazards of its use and the management relative to the consequential complications are reviewed and discussed.
Shieh
J P
JP
Department of Anesthesiology, Chi-Mei Foundation Hospital, Tainan, Taiwan, R.O.C.
Chu
C C
CC
Chen
J Y
JY
Chen
Y H
YH
Yeh
F C
FC
Hsing
C H
CH
D000638:Amiodarone / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000150:complications; D014664:Vasodilation / Q000187:drug effects*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone