title: [Second-degree atrioventricular block (Mobitz type II) probably exaggerated by dopamine during anesthetic management for a patient with ochronosis: a case report].
abstract: Ochronosis is a rare disease. Usually symptoms appear in the third, fourth, or later decade of life. The most common symptom is arthropathy, but cardiovascular system can be involved in this disease. A 71-year-old man with ochronosis was scheduled for total hip arthroplasty. Preoperatively, echocardiogram revealed aortic valve stenosis, mitral valve stenosis, and hypokinesis on antero-septal, lateral and posterior walls. Coronary angiogram revealed 50-75% stenosis of the left anterior descending coronary artery (segment 7) and 100% stenosis of the left circumflex artery (segment 15). Before the induction of general anesthesia, electrocardiogram showed first-degree atrioventricular block. After the induction of general anesthesia, blood pressure decreased markedly. Phenylephrine administration and rapid infusion of extracellular fluid failed to increase blood pressure. Thus, we started to administer dopamine at an infusion rate of 10 microg x kg(-1) x min(-1) which increased blood pressure effectively, but electrocardiogram showed second-degree atrioventricular block (Mobitz type II). We started rapid infusion of a plasma substitute, and gradually decreased the infusion rate of dopamine to 4 microg x kg(-1) x min(-1). Then electrocardiogram returned to first-degree atrioventricular block. We estimated that second-degree atrioventricular block in this patient might have been exaggerated by dopamine at least in part.
authors.affiliation: Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kitamura
authors.forename: Nagara
authors.initials: N
authors.lastname: Ohno
authors.forename: Masahiko
authors.initials: M
authors.lastname: Bougaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Saito
authors.forename: Ryo
authors.initials: R
authors.lastname: Orii
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D019644:Arthroplasty, Replacement, Hip; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D004298:Dopamine / Q000008:administration & dosage / Q000009:adverse effects*; D004562:Electrocardiography; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D016343:Monitoring, Intraoperative; D009794:Ochronosis / Q000150:complications*; D015207:Osteoarthritis, Hip / Q000209:etiology / Q000601:surgery; D012720:Severity of Illness Index
chemical_list: D002316:Cardiotonic Agents; D004298:Dopamine