title: Effect of isoflurane on defibrillation threshold in biphasic active-can defibrillation systems.
abstract: In two patients receiving implantable cardioverter-defibrillators (ICD) for spontaneous and inducible ventricular tachyarrhythmias, the use of isoflurane appeared to significantly lower defibrillation thresholds (DFT) at implantation. In the first, at initial implantation and subsequent revision using isoflurane, adequate DFTs were verified by multiple tests. Post-implantation testing using midazolam and fentanyl revealed significantly higher DFTs, necessitating a third operation without isoflurane to obtain an adequate and subsequently verifiable DFT. During the second case, discontinuation of isoflurane intraoperatively resulted in a DFT rise within 25 minutes. In patients receiving general anesthesia for ICD implantation, this possible DFT effect of isoflurane should be recognized.
authors.affiliation: Division of Cardiology, Departmernt of Internal Medicine, Northwestern University, Northwestern Memorial Hospital, 710 N. Fairbanks Ct., Room 7428, Chicago, IL 60611, USA. ghorvath@nwu.edu
authors.forename: G
authors.initials: G
authors.lastname: Horvath
authors.forename: M
authors.initials: M
authors.lastname: Ilan
authors.forename: A
authors.initials: A
authors.lastname: Kadish
authors.forename: J
authors.initials: J
authors.lastname: Goldberger
mesh_terms: D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D017147:Defibrillators, Implantable; D006801:Humans; D007530:Isoflurane / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017180:Tachycardia, Ventricular / Q000628:therapy*
chemical_list: D018686:Anesthetics, Intravenous; D007530:Isoflurane