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[Mobitz type II block during one-lung ventilation].
Kazuhiro Shibuya1, Tadahiko Ishiyama, Manabu Ichikawa
1Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, Chuo 409-3898.
Masui. the Japanese Journal of Anesthesiology
|March 17, 2010
Summary
This case study highlights a rare Mobitz type II atrioventricular block during lung cancer surgery. Anesthesia agents and thoracic epidural anesthesia may trigger this cardiac event, suggesting external pacing is unsuitable for thoracic procedures.
Area of Science:
- Anesthesiology
- Cardiology
- Thoracic Surgery
Background:
- A 74-year-old male with lung cancer underwent thoracic surgery requiring one-lung ventilation.
- Preoperative assessment revealed normal sinus rhythm and stable hemodynamics.
- Anesthesia involved propofol, fentanyl, vecuronium, and thoracic epidural anesthesia with mepivacaine.
Observation:
- During one-lung ventilation, the patient developed Mobitz type II atrioventricular block with significant bradycardia (30 bpm).
- External pacing was initiated but caused patient movement, disrupting the surgery and failing to stabilize blood pressure.
- Administration of atropine and dopamine managed hemodynamics despite persistent Mobitz type II block.
Findings:
- Propofol, fentanyl, and thoracic epidural anesthesia are potential causative factors for Mobitz type II atrioventricular block in this context.
- External pacing proved ineffective and detrimental during thoracic surgery due to patient movement and inadequate hemodynamic support.
- The patient's cardiac rhythm spontaneously resolved the following day without intervention.
Implications:
- This case suggests a potential link between specific anesthetic agents/techniques and the development of high-grade atrioventricular block during thoracic procedures.
- External pacing is strongly discouraged for managing bradyarrhythmias during thoracic surgeries due to practical limitations and potential complications.
- Alternative management strategies for bradycardia in thoracic surgery patients receiving these anesthetic agents warrant further investigation.
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