J unctional ectopic tachycardia (JET) has been observed in up to 11.4% of pediatric patients after cardiac surgery and is the most common tachyarrhythmia during the early postoperative period. 1 Following surgery, the heart is vulnerable to the negative effects of a high heart rate and atrioventriular (AV) asynchrony, which can lead to hemodynamic instability, decreasing cardiac output. Accurate identification of JET is critical because it is not amenable to synchronized cardioversion and is an important factor in postoperative morbidity. 1 The following case is an example of the cardioversion attempt of a perfusing tachyarrhythmia mistakenly identified as supraventricular tachycardia (SVT).
Case ReportA 5-month-old, 8.7-kg, female infant underwent surgical treatment of complete atrial-ventricular septal defect with a common atrium, left-looped ventricles, pulmonary atresia with confluent pulmonary arteries, and dextrocardia. A Glenn shunt and AV valvuloplasty was performed with a cardiopulmonary bypass time of 225 minutes and aortic cross-clamp time of 47 minutes.Adenosine was successfully used in the operating room for SVT after cardiopulmonary bypass was discontinued. Intermittent tachycardia continued throughout the first postoperative night. The morning of postoperative day 1, the patient was tachycardiac ( Ͼ 200/min) with a variable arterial blood pressure. Supraventricular tachycardia was suspected, and the child was cardioverted using 0.5 J/kg of body weight ( Figure 1 ). Immediately afterward ventricular fibrillation occurred without measurable blood pressure or detectable pulse. Defibrillation using 2 J/kg of body weight was immediately performed with restoration of tachyarrhythmia (220/min) with variable blood pressure present ( Figure 2 ). Cardiologists were contacted and
This report provides a description and discussion of a 19-year-old, 65-kg male, with a large mediastinal mass, right pleural effusion, and pericardial effusion, requiring urine alkalinization during a propofol infusion. The patient required NaHCO3 boluses, urine pH, electrolyte, arterial blood gas and lactate monitoring, and discontinuation of the propofol. The authors suggest that caution be used when prescribing a propofol infusion for patients who are at risk of tumor lysis syndrome and the need for urine alkalinization.
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