Abstract
Two groups of ASA physical status class III and IV patients undergoing cardiac surgery were reviewed in an attempt to obtain more conclusive data concerning dangerous interactions between amiodarone and anaesthesia. The amiodarone group (Group 1, ten patients, cumulative dose 10 g) was compared with a control group (nine patients, Group 2). Amiodarone (A) and desethylamiodarone (NA) concentrations in plasma and myocardium were measured and haemodynamic and antiarrhythmic effects were analysed. Throughout anaesthesia haemodynamic status was similar in both groups. No correlation was found between A/NA and cardiac index changes. No patients needed intraaortic blood pressure augmentation or developed low systemic vascular resistances. Pacemaker dependency was similar in both groups and there was no evidence of increased anaesthetic risk. An excellent antiarrhythmic effect was obtained during the postoperative period. We conclude that preoperative treatment with amiodarone is effective against postoperative arrhythmias.
Résumé
Dans le but d’éclaircir l’interaction dangereuse décrite entre l’amiodarone et l’anesthésie générate, nous avons comparé deux groupes de patients ASA III ou IV subissant une intervention à coeur ouvert soit un groupe amiodarone (Groupe 1: dix patients, dose cumulative 10 g) et un groupe contrôle (Groupe 2: neuf patients). Nous avons mesuré les concentrations myocardiques et plasmatiques d’amiodarone et de déséthylamiodarone ainsi que leurs effets antiarythmiques et hémodynamiques. Les profils hémodynamiques des deux groupes étaient comparables sauf pour une plus faible augmentation de l’index cardiaque dans le Groupe I. Nous n’avons pas trouvé de corrélation entre A,NA et les variations d’index cardiaque. Aucun patient n’a eu besoin de contrepulsion aortique ou n’a présente de résistances vasculaires périphériques trop basses. L’usage de pacemaker etait comparable dans les deux groupes et l’amiodarone n’a pas augmenté le risque anesthésique. L’effet antiarythmique obtenu pendant la période postopératoire était excellent. Nous concluons done que l’amiodarone en préopératoire prévient efficacement les arythmies postopératoires.
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Chassard, D., George, M., Guiraud, M. et al. Relationship between preoperative amiodarone treatment and complications observed during anaesthesia for valvular cardiac surgery. Can J Anaesth 37, 251–254 (1990). https://doi.org/10.1007/BF03005479
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DOI: https://doi.org/10.1007/BF03005479