Anesthetic management of an AAI pacemaker patient with paroxysmal atrial fibrillation during colorectal surgery.
Perioperative management of patients with cardiac pacemakers may be challenging because of the increasing sophistication of these devices. We report a case of a patient with paroxysmal atrial fibrillation (PAF) and with a permanent AAIR (bipolar atrial-inhibited adaptive rate) pacemaker who suffered life-threatening episodes of arrhythmias during operation. The first episode was vagally induced PAF during bowel manipulation; the second, induced by the increased pacing threshold from the external electric cardioversion and hyperkalemia. Transcutaneous pacing provided cardiac pacing and stabilized the patient during the second episode. Thorough preoperative evaluation and prophylactic placement of temporary pacing or at least transcutaneous pacing are important for the avoidance and minimization of intraoperative complications in patients with sick sinus syndrome and with an AAI (atrial inhibited) pacemaker.
Lin
Jui-An
JA
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan, and Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
Borel
Cecil O
CO
Wang
Wen-Been
WB
Wong
Chih-Shung
CS
Yeh
Chun-Chang
CC
Yang
Chih-Ping
CP
Wu
Ching-Tang
CT
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy; D001285:Atropine / Q000008:administration & dosage; D001919:Bradycardia / Q000150:complications / Q000188:drug therapy; D002125:Calcium Gluconate / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003107:Colorectal Surgery; D004298:Dopamine / Q000008:administration & dosage; D004554:Electric Countershock / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000188:drug therapy; D006336:Heart Massage / Q000379:methods; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007431:Intraoperative Complications / Q000628:therapy; D009102:Multiple Organ Failure; D010138:Pacemaker, Artificial; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D001285:Atropine; D000638:Amiodarone; D002125:Calcium Gluconate; D004298:Dopamine; D004837:Epinephrine