Practical management aspects of intraoperative arrhythmias: the anesthesiologist's viewpoint

A wide range of cardiac arrhythmias may be observed during anesthesia and intraoperatively and they usually have a multifactorial origin. A broad understanding of the various arrhythmogenic factors is important in the safe and effective treatment of these rhythm disorders. A large number of intraoperative arrhythmias can be successfully managed by expectant observation and elimination of the frequently implicated stimuli, e.g., hypercapnia, anesthetic overdose, hypoxia, excessive sympathetic activity, or surgical stimulation. Certain arrhythmias, however, depending on their intrinsic prognosis and the hemodynamic state of the patient, require immediate treatment with antiarrhythmic drugs or direct current countershock, or both.