Development of third-degree heart block due to thoracic epidural anaesthesia

McHugh, Stephen M.; Ibinson, James W.

doi:10.1016/j.injury.2011.11.004

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…In the present case, the epidural catheter was placed at the cardiac sympathetic nerve level, and the event disappeared after catheter removal, suggesting that sympathetic suppression by TEA caused complete AVB. Third-degree heart block has been documented following TEA in a patient with first-degree AVB [2]. In dogs, TEA prolonged atrioventricular node conduction time [4].…”

Section: Discussionmentioning

confidence: 96%

“…Our patient had no preoperative symptoms and the PR interval was not extremely long (0.204 s). The patient in the aforementioned report of complete AVB due to TEA also had first-degree AVB [2], which may have increased the risk of complete AVB during epidural anesthesia. MG is known to involve other body systems including the heart.…”

Section: Discussionmentioning

confidence: 98%

“…However, whether epidural anesthesia triggers complete AVB or not is not clearly indicated. To our knowledge, there has been only one case of complete AVB caused by epidural anesthesia alone, which was the first reported case in Japan [2].…”

Section: Introductionmentioning

confidence: 93%

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Complete atrioventricular block under epidural ropivacaine infusion in a patient with first-degree atrioventricular block and myasthenia gravis: a case report

2022

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Background First-degree atrioventricular block (AVB) may lead to complete AVB. Herein, we present a case of a complete AVB under thoracic epidural catheter infusion of ropivacaine with fentanyl in a patient with first-degree AVB and myasthenia gravis. Case presentation A 74-year-old woman with first-degree AVB underwent thymectomy for myasthenia gravis. Continuous thoracic epidural catheter infusion of 0.2% ropivacaine with fentanyl was initiated at 15 min before the end of the surgery. At 9 h postoperatively, the electrocardiogram showed a 10-s-long pause due to complete AVB. Thus, a temporary pacemaker was implanted, and at 19 h postoperatively on postoperative day 1, cardiac pacing was initiated and lasted approximately 30 s. After catheter removal, she had no further episodes of complete AVB. Conclusion First-degree AVB may lead to complete AVB under the influence of thoracic epidural infusion of ropivacaine in patients with myasthenia gravis.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

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Complete atrioventricular block under epidural ropivacaine infusion in a patient with first-degree atrioventricular block and myasthenia gravis: a case report

2022

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“…In addition, epidural anesthesia use during delivery can induce heart block. [ 5 ] In our patient in light of the normal systolic and diastolic function, her symptoms were attributed to diastolic MR secondary to heart block from epidural anesthesia in addition to increased blood volume due to pregnancy.…”

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confidence: 85%

An unusual cause of postpartum heart failure

et al. 2017

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“…Jacobson concluded that reduction in preload leading to an increase in vagal activity is responsible for arrest rather than blockade of cardiac accelerator nerves from the study on healthy volunteers receiving Cardiac Arrest Following Central Neuraxial Block DOI: http://dx.doi.org/10.5772/intechopen.106600 epidural [25]. Development of third-degree heart block is reported following thoracic epidural block in a patient having preoperative first-degree heart block [38]. Even though there is a segmental block during epidural, partial sympathetic block can be there in lower segments resulting in preload reduction [39].…”

Section: Intrinsic Cardiac Reflexesmentioning

confidence: 99%

Cardiac Arrest Following Central Neuraxial Block

Kulkarni¹,

Futane²

2023

Updates in Anesthesia - The Operating Room and Beyond

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Central neuraxial blocks (CNB) are used worldwide in anesthesia practice. They are safe, however, not devoid of untoward complications. Cardiac arrest (CA) is one of the major devastating complications. The anesthesiologists are concerned about CA as it can occur unexpectedly and suddenly even in a young ASA grade I patient, undergoing elective surgery, at any time during and after administration of CNB in spite of continuous vigilance. A better understanding of the physiology of CNB, availability of monitoring devices, and safer local anesthetic drugs contribute to reduced mortality, yet cases of CA are reported even recently. These case reports provide information relevant to particular incidents and may be inadequate to provide comprehensive information to explain the overall clinically important aspects related to CA following CNB. This chapter would provide a summary and analysis of the current recommendations about etiology, predisposing factors, preventive measures, and various measures tried for the treatment of cardiac arrest, although the exact etiology and predisposing factors are still not known. The comprehensive information would be helpful for anesthesiologists during day-to-day practice and to increase the safety of patients undergoing CNB. Proper patient selection, pre-/co-loading of fluids, the modifying technique of CNB as per patient’s need, early use of epinephrine during bradycardia refractory to atropine, continuous monitoring, vigilance during intra- and postoperative period would help in prevention, early detection, and prompt treatment of CA. Challenges faced by anesthesiologists during CNB practice and newer modalities used for the treatment of refractory CA are also discussed. The mystery of sudden unexpected CA is yet to be solved and research in this direction is warranted. Electronic medical record keeping and reporting untoward incidence to the national board will also help to improve patient safety in the future.

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Development of third-degree heart block due to thoracic epidural anaesthesia

Cited by 3 publications

References 16 publications

Complete atrioventricular block under epidural ropivacaine infusion in a patient with first-degree atrioventricular block and myasthenia gravis: a case report

Complete atrioventricular block under epidural ropivacaine infusion in a patient with first-degree atrioventricular block and myasthenia gravis: a case report

An unusual cause of postpartum heart failure

Cardiac Arrest Following Central Neuraxial Block

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