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Mobitz Type II Atrioventricular Block Followed by Remifentanil in a Patient with Severe Aortic Stenosis

Mehryar Taghavi Gilani1, Majid Razavi

  • 1Anesthesia Department, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Case Reports in Anesthesiology
|May 11, 2013
PubMed

Insights

Remifentanil, an opioid analgesic, can cause rare but serious bradycardia and conduction block in patients with aortic stenosis. Caution is advised when using remifentanil in this patient population.

Area of Science:

  • Anesthesiology
  • Cardiology
  • Pharmacology

Background:

  • Opioids are often chosen for their hemodynamic stability during anesthesia.
  • Remifentanil is an ultra-short-acting opioid analgesic known for rapid onset and offset.
  • Aortic stenosis poses unique challenges for anesthetic management due to altered hemodynamics.

Purpose of the Study:

  • To report a rare adverse event associated with remifentanil use in a patient with severe aortic stenosis.
  • To highlight the potential for severe bradycardia and conduction abnormalities with remifentanil in this specific patient group.

Main Methods:

  • Case report of an 84-year-old male patient undergoing general anesthesia for severe aortic stenosis.
  • Anesthetic regimen included fentanyl, pancuronium, propofol, and a combination of propofol and remifentanil.
  • Monitoring of hemodynamic parameters and cardiac conduction during anesthesia.

Main Results:

  • Initiation of remifentanil infusion led to bradycardia and Mobitz type II conduction block.
  • Hemodynamic instability, including decreased blood pressure, occurred.
  • Atropine and ephedrine partially improved blood pressure, but dysrhythmia resolved only after remifentanil discontinuation.

Conclusions:

  • Remifentanil can precipitate severe bradycardia and conduction disturbances in patients with aortic stenosis.
  • Anesthetic management in patients with aortic stenosis requires careful consideration of opioid selection.
  • Clinicians should exercise caution when administering remifentanil to patients with severe aortic stenosis due to potential cardiac adverse effects.

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