Heart block and prolonged Q-Tc interval following muscle relaxant reversal: A case report

AANA Journal

Volumn 76, Issue 1, 2008, Pages 41-45

  Shields, John A ^a,b  

^a VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^b Middle Tennessee School of Anesthesia   (United States)

Author keywords

Dexmedetomidine; Heart block; Neostigmine; Q T interval prolongation

Indexed keywords

ATROPINE; DESFLURANE; DEXMEDETOMIDINE; DOLASETRON MESILATE; DROPERIDOL; FENTANYL; FUROSEMIDE; LIDOCAINE; MUSCLE RELAXANT AGENT; NEOSTIGMINE; PROPOFOL; SUXAMETHONIUM; VECURONIUM;

ADULT; ANESTHESIA INDUCTION; ANKLE EDEMA; ARTICLE; CARDIOVASCULAR DISEASE; CASE REPORT; DISEASE PREDISPOSITION; FEMALE; FOOD AND DRUG ADMINISTRATION; HEART ARRHYTHMIA; HEART BLOCK; HUMAN; MORBID OBESITY; MUSCLE RELAXATION; POSTOPERATIVE NAUSEA; POSTOPERATIVE VOMITING; QT INTERVAL; QT PROLONGATION; ROUX Y ANASTOMOSIS; TORSADE DES POINTES;

ADJUVANTS, ANESTHESIA; ADULT; ANESTHESIA, INHALATION; ANESTHESIA, INTRAVENOUS; ANESTHETICS, INHALATION; ATROPINE; CHOLINESTERASE INHIBITORS; DEXMEDETOMIDINE; DROPERIDOL; DRUG MONITORING; ELECTROCARDIOGRAPHY; FEMALE; GASTRIC BYPASS; HEART BLOCK; HUMANS; HYPNOTICS AND SEDATIVES; INDOLES; ISOFLURANE; LONG QT SYNDROME; MUSCARINIC ANTAGONISTS; NEOSTIGMINE; NURSE ANESTHETISTS; OBESITY, MORBID; QUINOLIZINES; RISK FACTORS; SEROTONIN ANTAGONISTS;

EID: 38949129198     PISSN: 00946354     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (39)

1. Yildirim H, Adanir T, Atay A, Katircioglu K, Savaci S. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesthesiol. 2004;21:566-570.
2. Cubeddu LX. QT prolongation and fatal arrhythmias: a review of the clinical implications and effects of drugs. Am J Ther. 2003;10:452-457.
3. Saarnivaara L, Simola M. Effects of four anticholinesterase- anticholinergic combinations and tracheal extubation on QTc interval of the ECG, heart rate and arterial pressure. Acta Anaesthesiol Scand. 1998;42:460-463.
4. Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology. 1992;4:785-805.
5. Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91-108.
6. Biring MS, Lewis MI, Liu JT, Mohsenifar Z. Pulmonary physiologic changes of morbid obesity. Am J Med Sci. 1999;318:293-297.
7. Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg. 1998;87:654-660.
8. Rawal N, Sjostrand U, Christofferson E, Dahlstrom B, Arvill A, Rydman H. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence of postoperative ambulation and pulmonary function. Anesth Analg. 1984;63:583-592.
9. VanDercar DH, Martinez AP, De Lisser EA. Sleep apnea syndromes: a potential contraindication for patient-controlled analgesia. Anesthesiology. 1991;74:623-624.
10. Feld JM, Laurito CE, Beckerman M, Vincent J, Hoffman WE. Non-opioid analgesia improves pain relief and decreases sedation after gastric bypass surgery. Can J Anaesth. 2003;50:336-341.
11. Adriaenssens G, Vermeyen KM, Hoffman VL, Mertens E, Adriaensen HF. Postoperative analgesia with i.v. patient-controlled morphine: effect of adding ketamine. Br J Anaesth. 1999;83:393-396.
12. Aho MS, Erkola OA, Schenin H, Lehtinen AM, Korttila KT. Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation. Anesth Analg. 1991;73:112-118.
13. Virtanen R, Savola V, Nyman L. Characterization of selectivity, specificity and potency of medetomidine as alpha 2-adrenoreceptor agonist. Eur J Pharmacol. 1988;150:9-14.
14. Hofer RE, Sprung J, Sarr MG, Wedel DJ. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth. 2005;52:176-180.
15. Arain SR, Ruehlow RM, Ulrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004;98:153-158.
16. Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834-839.
17. Aho M, Lehtinen A, Kallio A, Korttila K. The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy Anesthesiology. 1991;74:997-1002.
18. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. Anesthesiology. 1992;77:1134-1142.
19. Kallio A, Scheinin M, Koulu M, et al. Effects of dexmedetomidine, a selective alpha 2-adrenoreceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989;46:33-42.
20. Lonsdale M, Stuart J. Complete heart block following glycopyrronium/ neostigmine mixture. Anaesthesia. 1989;44:448-449.
21. Mirakhur RK, Dundee JW, Clarke RS. Glycopyrrolate-neostigmine mixture for antagonism of neuromuscular block: comparison with atropine-neostigmine mixture. Br J Anaesth. 1977;49:825-943.
22. Silay E, Kati I, Tekin M, et al. Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion. Acta Cardiol. 2005;60:459-464.
23. Baltzer L, Kris MG, Hinkley L et al. Reversible electrocardiographic interval prolongations following the specific serotonin antagonists ondansetron and dolasetron: a possible drug class effect without sequelae? In: Proceedings from the American Society of Clinical Oncology. May 1994; Dallas, Texas. Abstract 1489.
24. White PF, Song D, Abrao J, Klein KW, Navarette B. Effect of low-dose droperidol on the QT interval during and after general anesthesia: a placebo-controlled study. Anesthesiology. 2005;102:1101-1105.
25. Lischke V, Behne M, Doelken P, Schledt U, Probst S, Vettermann J. Droperidol causes a dose-dependent prolongation of the QT interval. Anesth Analg. 1994;79:983-986.
26. Navari RM, Koeller JM. Electrocardiographic and cardiovascular effects of the 5-hydroxytryptamine3 receptor agonists. Ann Pharmacother. 2003;37:1276-1286.
27. Ciaccheri M, Dolera A, Manetti A, Botti P, Zorn M, Peruzzi S. A-V block by an overdose of clonidine. Acta Cardiol. 1983;38:233-236.
28. Clementy J, Castagne D, Wicker P, Dallocchio M, Bricaud H. Study of the electrophysiologic properties of clonidine administered intravenously. J Cardiovasc Pharmacol. 1986;8(suppl 3):S24-S29.
29. Ingersoll-Weng E, Manecke GR Jr, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology. 2004;100:738-739.
30. Berkenbosch JW, Tobias JD. Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxm. Pediatr Crit Care Med. 2003;4:203-205.
31. Precedex [package insert]. Lake Forest, IL: Hospira Pharmaceuticals; 2004.
32. Bovill JG, Sebel PS, Stanley TH. Opioid analgesics in anesthesia: with special reference to their use in cardiovascular anesthesia. Anesthesiology. 1984;61:731-755.
33. Lischke V, Wilke HJ, Probst S, Behne M, Kessler P. Prolongation of QT interval during induction of anesthesia in patients with coronary artery disease. Acta Anaesthesiol Scand. 1994;38:144-148.
34. Shalom FM, Santora LJ, Iseri LT, Henry WL. Electrocardiogram observations before, during and after rapid weight loss in morbidly obese subjects [abstract]. Circulation. 1981;64:81.
35. el-Gamal A, Gallagher D, Nawras A, et al. Effects of obesity on QT, RR and QTc intervals. Am J Cardiol. 1995;75:956-959.
36. Seyfeli E, Duru M, Kuvandik G, Kaya H, Yalcin F. Effect of obesity on P-wave dispersion and QT dispersion in women. Int J Obes (Lond). 2006;30:957-961.
37. Kääb S, Pfeufer A, Hinterseer M, Nabauer M, Schulze-Bahr E. Long QT syndrome: why does sex matter? Z Kardiol. 2004;93:641-645.
38. Whyte SD, Booker PD, Buckley DG. The effects of propofol and sevoflurane on the QT interval and transmural dispersion or repolarization in children. Anesth Analg. 2005;100:71-77.
39. Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F. Reversing sevoflurane-associated QTc prolongation by changing to propofol. Anaesthesia. 2001;56:248-250.