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[Complete heart block after spinal and general anaesthesia].
1Institut für Anästhesiologie und Intensivmedizin, Stadtspital Triemli, Zürich, Switzerland. christoph.hofer@triemli.stzh.ch
Der Anaesthesist
|April 26, 2003
Summary
Complete atrioventricular block can occur during anesthesia in older patients with hypertension. Maintaining blood pressure and using pacing are crucial for preventing and managing this serious cardiac event.
Area of Science:
- Cardiology
- Anesthesiology
Background:
- A 74-year-old patient with hypertension but no prior conduction abnormalities developed complete atrioventricular block during anesthesia.
- This event recurred during a subsequent operation, despite a different anesthetic technique.
Observation:
- A significant drop in arterial pressure (>40%) preceded the atrioventricular block during both anesthetic episodes.
- The patient had underlying, though discrete, hypertensive heart disease.
Findings:
- The study suggests relative ischemia of the atrioventricular region as a potential cause.
- Successful management involved drug therapy and transcutaneous pacing.
- During the second operation, invasive blood pressure monitoring and catecholamine support prevented recurrence.
Implications:
- Intraoperative complete atrioventricular block can occur in older patients with hypertension, even without pre-existing conduction issues.
- Transcutaneous pacing should be readily available in such cases.
- Maintaining adequate coronary perfusion pressure through invasive monitoring and support is essential.