title: Altered responses to vasopressors of a patient medicated with carvedilol, pilsicainide and enalapril.
abstract: A patient scheduled for laparoscopic rectal surgery was medicated with carvedilol, an antagonist of beta 1-, beta 2- and alpha 1-adrenergic receptors, pilsicainide, a class Ic antiarrhythmic drug and enalapril, an angiotensin-converting enzyme inhibitor. Because the patient experienced attacks of atrial fibrillation with rapid ventricular response almost weekly, carvedilol and pilsicainide were continued up to the day of surgery, while enalapril was discontinued for 24 h prior to surgery. During the operation, he showed prolonged hypotension that did not respond to usual doses of vasopressors such as ephedrine, phenylephrine and dopamine but responded to higher doses of norepinephrine. Postoperatively, he was given dopamine but exhibited tachyarrhythmia until the dopamine infusion was discontinued.
authors.affiliation: Kyoto City Hospital, 1-2 Mibu-Higashitakadacho, Nakagyo-ku, Kyoto, 604-8845, Japan, kumin@da2.so-net.ne.jp.
authors.forename: Kumi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Norihiko
authors.initials: N
authors.lastname: Fukami
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D002227:Carbazoles / Q000009:adverse effects*; D000077261:Carvedilol; D004347:Drug Interactions; D004656:Enalapril / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000503:physiopathology; D008012:Lidocaine / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002227:Carbazoles; D011412:Propanolamines; D014662:Vasoconstrictor Agents; D000077261:Carvedilol; D004656:Enalapril; D008012:Lidocaine; C042288:pilsicainide