Canadian Journal of Anaesthesia

, Volume 43, Issue 4, pp 394–398 | Cite as

Neostigmine-induced bradycardia following recent vs remote cardiac transplantation in the same patient

  • Steven B. Backman
  • Reuben D. Stein
  • Fiona E. Ralley
  • Gordon S. Fox
Clinical Reports

Abstract

Purpose

This report describes the effects of neostigmine on heart rate in the same patient following recent and remote cardiac transplantation.

Clinical features

Eighty-six months following the first transplant, neostigmine 5.0 μg · kg−1 iv produced a 10% reduction in heart rate which was reversed by atropine 1.2 mg. For 24 months prior to this initial study, the patient experienced angina, suggesting cardiac afferent reinnervation. Three months after the second heart transplant, a second study showed that a six-fold increase in the dose of neostigmine, 30.0 μg · kg−1, only produced a 3.5% reduction in heart rate which was reversed by atropine 1.2 mg.

Conclusions

These observations indicate that neostigmine produces bradycardia following cardiac transplantation, and suggest that a greater response may be observed in remotely than in recently transplanted patients.

Key words

anticholinesterase: neostigmine heart: transplantation 

Résumé

Objectif

Cette observation décrit les effets de la néostigmine chez le même patient entre une première et une deuxième transplantations cardiaques.

Caractéristiques cliniques

Quatre-vingt-six mois après une première transplantation, de la néostigmine 5,0 μg · kg−1 iv a provoqué une baisse de la fréquence cardiaque de 10% neutralisée par l’atropine 1,2 mg. Vingt-quatre mois après le début de cette étude, le patient souffrait d’angine, ce qui suggérait une réinnervation cardiaque afférente. Trois mois après la seconde transplantation, une autre étude a révélé que six fois la dose initiale de neostigmine, 30,0 μg · kg−1, ne produisait qu’une baisse de 3,5% de la fréquence cardiaque laquelle a été neutralisée par l’atropine 1,2 mg.

Conclusions

Cette observation montre que la néostigmine produit de la bradycardie après une transplantation cardiaque et suggère que cette réponse peut être plus importante chez le patient dont la transplantation est de plus longue date.

References

  1. 1.
    Baraka A. Safe reversal (2) atropine-neostigmine mixture. Br J Anaesth 1968; 40: 30–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Bernardi L, Keller F, Sanders M, et al. Respiratory sinus arrhythmia in the denervated human heart. J Appl Physiol 1989; 67: 1447–55.PubMedGoogle Scholar
  3. 3.
    Fallen EL, Kamath MV, Ghista DN, Fitchett D. Spectral analysis of heart rate variability following human heart transplantation: evidence for functional reinnervation. J Auton Nerv Syst 1988; 23: 199–206.PubMedCrossRefGoogle Scholar
  4. 4.
    Kavanagh T, Yacoub MH, Mertens DJ, Kennedy J, Campbell RB, Sawyer P. Cardiorespiratory responses to exercise training after orthotopic cardiac transplantation. Circulation 1988; 77: 162–71.PubMedGoogle Scholar
  5. 5.
    Rudas L, Pflugfelder PW, Kostuk WJ. Vasodepressor syncope in a cardiac transplant recipient: a case of vagal re-innervation. Can J Cardiol 1992; 8: 403–5.PubMedGoogle Scholar
  6. 6.
    Rudas L, Pflugfelder PW, Menkis AH, Novick RJ, McKenzie FN, Kostuk WJ. Evolution of heart rate responsiveness after orthotopic cardiac transplantation. Am J Cardiol 1991; 68: 232–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Sands KEF, Appel ML, Lilly LS, Schoen FJ, Mudge GH Jr, Cohen RJ. Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation 1989; 79: 76–82.PubMedGoogle Scholar
  8. 8.
    Schwaiger M, Hutchins GD, Kalff V et al. Evidence for regional catecholamine uptake and storage sites in the transplanted human heart by positron emission tomography. J. Clin Invest 1991; 87: 1681–90.CrossRefGoogle Scholar
  9. 9.
    Shaver JA, Leon DF, Gray S III, Leonard JJ, Bahnson HT. Hemodynamic observations after cardiac transplantation. N Eng J Med 1969; 281: 822–7.Google Scholar
  10. 10.
    Smith ML, Ellenbogen KA, Eckberg DL, Sheehan HM, Thames MD. Subnormal parasympathetic activity after cardiac transplantation. Am J Cardiol 1990; 66: 1243–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Stinson EB, Griepp RB, Schroeder JS, Dong E Jr, Shumway NE. Hemodynamic observations one and two years after cardiac transplantation in man. Circulation 1972; 45: 1183–1194.PubMedGoogle Scholar
  12. 12.
    Wilson RF, Christensen BV, Olivari MT, Simon A, White CW, Laxson DD. Evidence for structural sympathetic reinnervation after orthotopic cardiac transplantation in humans. Circulation 1991; 83: 1210–20.PubMedGoogle Scholar
  13. 13.
    Backman SB, Bachoo M, Polosa C. Mechanisms of the bradycardia produced in the cat by the anticholinesterase neostigmine. J Pharmacol Exp Ther 1993; 265: 194–200.PubMedGoogle Scholar
  14. 14.
    Brehm G, Lindmar R, Löffelholz K. Inhibitory and excitatory muscarinic receptors modulating the release of acetylcholine from the postganglionic parasympathetic neuron of the chicken heart. Naunyn Schmiedebergs Arch Pharmacol 1992; 346: 375–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Backman SB, Ralley FE, Fox GS. Neostigmine produces bradycardia in a heart transplant patient. Anesthesiology 1993; 78: 777–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Backman, SB, Fox, GS, Stein, RD, Ralley, FE. Neostigmine decreases heart rate in heart transplant patients. Can J Anaesth (this issue).Google Scholar
  17. 17.
    Cheng DCH, Ong DD. Anaesthesia for non-cardiac surgery in heart transplanted patients. Can J Anaesth 1993; 40: 981–6.PubMedGoogle Scholar
  18. 18.
    Eisenkraft JB, Dimich I, Sachdev VP. Anesthesia for major noncardiac surgery in a patient with a transplanted heart. Mt Sinai J Med 1981; 48: 116–20.PubMedGoogle Scholar
  19. 19.
    Grebenik CR, Robinson PN. Cardiac transplantation at Harefield. A review from the anaesthetist’s standpoint. Anaesthesia 1985; 40: 131–40.PubMedGoogle Scholar
  20. 20.
    Kanter SF, Samuels SI. Anesthesia for major operations on patients who have transplanted hearts. A review of 29 cases. Anesthesiology 1977; 46: 65–88.PubMedCrossRefGoogle Scholar
  21. 21.
    Stark RP, McGinn AL, Wilson RF. Chest pain in cardiactransplant recipients. Evidence of sensory reinnervation after cardiac transplantation. N Eng J Med 1991; 324: 1791–4.Google Scholar
  22. 22.
    Uretsky BF. Sensory reinnervation of the heart after cardiac transplantation (Letter). N Eng J Med 1992; 326: 66–7.CrossRefGoogle Scholar
  23. 23.
    Kaseda S, Zipes DP. Supersensitivity to acetylcholine of canine sinus and AV nodes after parasympathetic denervation. Am J Physiol 1988; 255: H534–9.PubMedGoogle Scholar
  24. 24.
    Smith DC, Priola DV, Anagnostelis C. Comparison ofin vivo andin vitro cholinergic responses of normal and denervated canine hearts. J Pharmacol Exp Ther 1985; 235: 37–44.PubMedGoogle Scholar
  25. 25.
    Backman SB, Ralley FE, Fox GS. Anaesthesia for cardiac transplant patients (Letter). Can J Anaesth 1994; 41: 655.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1996

Authors and Affiliations

  • Steven B. Backman
    • 1
  • Reuben D. Stein
    • 1
  • Fiona E. Ralley
    • 1
  • Gordon S. Fox
    • 1
  1. 1.Department of AnaesthesiaRoyal Victoria Hospital and McGill UniversityUSA

Personalised recommendations