Progression of first degree heart block to high-grade second degree block during spinal anaesthesia
- 1.2k Downloads
- 8 Citations
Abstract
A case is presented in which a patient with pre-existing first degree heart block developed high-grade second degree heart block during spinal anaesthesia. Progression of the block was associated with blockade of cardiac sympathetic neurons induced by spinal anaesthesia. This suggests that patients with pre-existing heart block may be at increased risk for development of higher grade block during spinal anaesthesia.
Key words
anaesthetic techniques: spinal heart: arrhythmia parasympathetic nervous system sympathetic nervous systemRésumé
Le cas présenté est celui d’un patient porteur d’un bloc cardiaque du premier degré à l’ évaluation préopératoire, et qui a développé un bloc du deuxième degré de haut niveau lors d’une anesthésie sous-arachnoïdienne. La progression du bloc était associée au blocage des neurones sympathiques cardiaques induit par l’anesthésie sous-arachnoïdienne. Ceci suggère que les patients avec un bloc cardiaque à l’ évaluation préopératoire peuvent être a risque de développer un bloc de haut niveau pendant une anesthésie sous-arachnoïdienne.
References
- 1.Chester WL. Spinal anesthesia, complete heart block, and the precordial chest thump: an unusual complication and a unique resuscitation. Anesthesiology 1988; 69: 600–2.PubMedCrossRefGoogle Scholar
- 2.Westone WL, Wong KC. Sinus bradycardia and asystole during spinal anesthesia. Anesthesiology 1974; 41: 87–9.Google Scholar
- 3.Chung EK. Principals of Cardiac Arrythmias. Baltimore: Williams and Wilkins, 1989, 295.Google Scholar
- 4.Greene NM. The area of differential block during spinal anesthesia with hyperbaric tetracaine. Anesthesiology 1958; 19: 45–50.PubMedCrossRefGoogle Scholar
- 5.Chamberlain DP, Chamberlain BDL. Changes in skin temperature of the trunk and their relation to sympathetic blockade during spinal anesthesia. Anesthesiology 1986; 65: 139–43.PubMedCrossRefGoogle Scholar
- 6.Prystowsky EN, Jackman WM, Rinkenberger RL, Heger JJ, Zipes DP. Effect of autonomic blockade on ventricular refractoriness and atrioventricular nodal conduction in humans. Evidence supporting direct cholinergic action on ventricular muscle refractoriness. Circ Res 1981; 49: 511–8.PubMedGoogle Scholar
- 7.Irisawa H, Giles WR. Sinus and atrioventricular node cells: cellular electrophysiology.In: Zipes DP, Jaliffe J (Eds.). Cardiac Electrophysiology from Cell to Bedside. Philadelphia: WB Saunders, 1990: 95–102.Google Scholar
- 8.Chung EK. Principals of Cardiac Arrythmias. Baltimore: Williams and Wilkins, 1989; 281.Google Scholar
- 9.Watanabe Y, Dreifus LS. Atrioventricular block: basic concepts.In: Mandel WJ (Ed.). Cardiac Arrythmias: Their Mechanisms, Diagnosis and Management. Philadelphia: JB Lippincott, 1980: 406–36.Google Scholar
- 10.Corr PB, Yamada KA, Witkowski FX. Mechanisms controlling cardiac autonomic function and their relation to arrythmogenesis.In: Fozzard HA, Haber E, Jennings RB, Katz AM, Morgan HE (Eds.). The Heart and Cardiovascular System. New York: Raven Press, 1986: 1343–403.Google Scholar
- 11.Johnson RL, Averill KH, Lamb LE. Electrocardiographic findings in 67,375 asymptomatic subjects VII: atrioventricular block. Am J Cardiol 1960; 6: 153–77.PubMedCrossRefGoogle Scholar
- 12.Baron JF, Decaux-Jacolot A, Edouard A, Berdeaux A, Kamran S. Influence of venous return on baroreflex control of heart rate during lumbar epidural anesthesia in humans. Anesthesiology 1986; 64: 188–93.PubMedCrossRefGoogle Scholar