title: [A case of atropine-resistant bradycardia in a patient on long-term lithium medication].
abstract: A 44-year-old woman was scheduled for laparoscopic cholecystectomy and partial thyroidectomy. She had received lithium, 400-1200 mg daily, and other antidepressants for 10 years for her depressive disorder. Preoperative examination revealed a swelling of the right thyroid associated with hypothyroidism. Her heart rate was in the range of 45-70 min-1 preoperatively. After induction of anesthesia with propofol 50 mg, and fentanyl 100 micrograms, heart rate decreased to 36 min-1 and remained low after tracheal intubation. Atropine sulfate 1.1 mg in divided doses, and ephedrine 4 mg i.v. did not change the heart rate. However, a bolus of isoproterenol 0.02 mg i.v. increased the heart rate to 95 min-1. We suspect that atropine-resistant bradycardia was due to sinus node dysfunction produced by interaction of chronic lithium treatment, fentanyl and propofol. Therefore, an intractable sinus node dysfunction may occur in a patient in whom lithium is given chronically, particularly in whom hypothyroidism is associated. In such a patient, a beta-adrenergic stimulant may be effective in treating bradycardia.
authors.affiliation: Department of Anesthesiology, Kansai Medical University, Osaka 570-8507.
authors.forename: Y
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: S
authors.initials: S
authors.lastname: Nakao
authors.forename: T
authors.initials: T
authors.lastname: Asai
authors.forename: K
authors.initials: K
authors.lastname: Shingu
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D001285:Atropine / Q000494:pharmacology*; D001919:Bradycardia / Q000188:drug therapy / Q000209:etiology*; D017081:Cholecystectomy, Laparoscopic; D003866:Depressive Disorder / Q000188:drug therapy; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000503:physiopathology; D008094:Lithium / Q000008:administration & dosage / Q000009:adverse effects*; D013965:Thyroidectomy
chemical_list: D000889:Anti-Arrhythmia Agents; D001285:Atropine; D008094:Lithium