Supraventricular tachyarrhythmias and their management in the perioperative period

Stewart, Alexander Michael; Greaves, Kim; Bromilow, J.

doi:10.1093/bjaceaccp/mku018

Cited by 14 publications

(22 citation statements)

References 15 publications

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“…Fortunately, the anesthesiologist decided to reference an EM before continuing with further management, rather than relying on rote memory. Although the initial decision of rate control with pharmacologic therapy versus immediate synchronized cardioversion typically depends on hemodynamic instability, electrical cardioversion would have mechanically interfered with critical steps of the exploratory laparotomy and was to be avoided in this circumstance unless deemed absolutely necessary [12][13]. The decision of which pharmacologic agent to use for rate control was ambiguous, as all three first-line agents can potentially lower blood pressure through different mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Use of Emergency Manuals to Treat Intraoperative Supraventricular Tachycardia and Hypotension During Exploratory Laparotomy

Sanchez

Eskander

Elnagar

et al. 2020

Cureus

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Although intraoperative tachyarrhythmias are relatively common, their appropriate management is pertinent to reducing morbidity and mortality. In certain clinical scenarios, the initial steps of managing intraoperative tachyarrhythmias may be ambiguous. Emergency manuals (EMs) are cognitive aids that improve the outcome of critical events by providing current, medically established guidelines on management. The case of a patient with an intraoperative supraventricular tachycardia with narrow, irregular QRS complexes and refractory hypotension is described here. Relevant sections of Stanford Anesthesia Emergency Manual were activated immediately and guided the anesthesiologists in treating the patient's arrhythmia. The utilization of an EM allowed rapid selection of a pharmacologic agent that achieved hemodynamic stability. EMs allow healthcare providers to respond more appropriately and efficiently during critical events and thus directly improve patient care.

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Section: Discussionmentioning

confidence: 99%

Use of Emergency Manuals to Treat Intraoperative Supraventricular Tachycardia and Hypotension During Exploratory Laparotomy

Sanchez

Eskander

Elnagar

et al. 2020

Cureus

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“…Bradycardia (heart rate < 40 beat/minute) with hemodynamic instability (20% drop of the mean arterial blood pressure) was treated by intravenous atropine in a dose of 0.3-0.5 mg. For the treatment of supraventricular tachycardia (SVT), AF, or ventricular tachycardia (VT) with stable hemodynamics, intravenous amiodarone (150 mg over 10 minutes, then 1 mg/minute for 6 hours, then 0.5 mg/ minutes for 18 hours); however, in the case of hemodynamic instability, synchronized direct current (DC) cardioversion in a dose of 120-200 J (biphasic) was utilized for AF and SVT. Ventricular fibrillation (VF) and VT with hemodynamic instability were treated by non-synchronized DC at a starting energy dose of 100 J (biphasic) [13][14][15].…”

Section: Management Of Arrhythmiamentioning

confidence: 99%

Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial

Allah

Bakr

Abdelrahman

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Cardiac arrhythmias are not uncommon during and after coronary artery bypass graft cardiac surgeries. Preliminary studies showed the preventive effects of stellate ganglion block upon cardiac arrhythmias; however, this could be the 1 st study focusing upon intraoperative arrhythmias during offpump coronary artery bypass graft surgery as a main goal. Methods: This is a randomized controlled trial. The study involved forty adult patients undergoing elective offpump coronary artery bypass graft surgery. Twenty patients received left SGB with 10 ml of 2% lidocaine before induction of anesthesia (B group), and twenty patients as a control group (A group). Intraoperative and 24-hours postoperative electrocardiogram and hemodynamics were monitored, in addition to the mean postoperative 24-hours inotropic score. Results: There was a significantly higher incidence of intraoperative arrhythmias in the control group in the form of bradyarrhythmia (25%), supraventricular tachycardia (30%), atrial fibrillation (5%), ventricular tachycardia (10%), and ventricular fibrillation (5%) in comparison to the block group where atrial fibrillation occurred only in 4 patients (20%) with the p value of 0.007. Mean arterial blood pressure and heart rate showed significantly lower values in the SGB group intraoperatively. Postoperative mean 24-hour inotropic score and hemodynamics showed insignificant differences. Conclusion: Preoperative left stellate ganglion block can decrease incidence of arrhythmias during offpump coronary artery bypass graft surgeries. The technique showed a safe profile upon hemodynamics during the study period.

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“…Sinus tachycardia (ST) represents an appropriate autonomic response to a physiological stress. The upper limit of normal rate for sinus tachycardia is calculated from the formula Coronary Artery Bypass Graft Surgery (220 bpm minus age) [125]. Inappropriate ST may be seen in some patients, especially with young age, but it is rare and should be considered a diagnosis of exclusion [125].…”

Section: Epidemiologymentioning

confidence: 99%

“…The upper limit of normal rate for sinus tachycardia is calculated from the formula Coronary Artery Bypass Graft Surgery (220 bpm minus age) [125]. Inappropriate ST may be seen in some patients, especially with young age, but it is rare and should be considered a diagnosis of exclusion [125]. The term 'SVT' refers to paroxysmal tachyarrhythmias that require atrial or AV nodal tissue, or both, for their initiation and maintenance [126].…”

Section: Epidemiologymentioning

confidence: 99%

Arrhythmias Post Coronary Artery Bypass Surgery

Al‐Ghamdi¹

2017

Coronary Artery Bypass Graft Surgery

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Arrhythmias are common after cardiac surgery such as coronary artery bypass grafting surgery. Although most of these arrhythmias are transient and have a benign course, it may represent a significant source of morbidity and mortality. Postoperative arrhythmias (POAs) include atrial tachyarrhythmias, ventricular arrhythmias, and bradyarrhythmias. The incidence of POAs has not changed despite improvements in anesthetic and surgical techniques. The tachyarrhythmias in the postoperative period include atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia. The clinical significance of each arrhythmia depends on several factors that include cardiac function, patient's comorbidities, arrhythmia duration, and ventricular response rate. Tachycardia with uncontrolled ventricular rates can cause diastolic and later on systolic dysfunction, reduce cardiac output, and result in hypotension or myocardial ischemia. In the other hand, bradyarrhythmias may have a remarkable influence on patients with systolic or diastolic ventricular dysfunction. Arrhythmia management starts preoperatively with optimizing the patient's condition and controlling patient's risk factors, intraoperatively with careful attention to hemodynamic changes during surgery and uses appropriate anesthesia, and postoperatively with correction of temporary and correctable predisposing factors, as well as specific therapy for the arrhythmia itself. The POAs treatment urgency and management options are determined by the clinical presentation of the arrhythmia.

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Supraventricular tachyarrhythmias and their management in the perioperative period

Cited by 14 publications

References 15 publications

Use of Emergency Manuals to Treat Intraoperative Supraventricular Tachycardia and Hypotension During Exploratory Laparotomy

Use of Emergency Manuals to Treat Intraoperative Supraventricular Tachycardia and Hypotension During Exploratory Laparotomy

Preoperative left stellate ganglion block: Does it offer arrhythmia-protection during off-pump CABG surgery? A randomized clinical trial

Arrhythmias Post Coronary Artery Bypass Surgery

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