Accelerated Idioventricular Rhythm Following Intraoral Local Anesthetic Injection During General Anesthesia

2021 ◽  
Vol 68 (4) ◽  
pp. 230-234
Author(s):  
Kenichi Sato ◽  
Yoshihisa Miyamae ◽  
Miwako Kan ◽  
Shu Sato ◽  
Motoi Yaegashi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Local Anesthetic ◽  
Normal Sinus Rhythm ◽  
Excessive Pressure ◽  
Trigeminocardiac Reflex ◽  
Anesthetic Agents ◽  
Normal Sinus ◽  
Idioventricular Rhythm ◽  
Local Anesthetic Injection ◽  
Local Anesthetic Infiltration

Some anesthetic agents or adjunct medications administered during general anesthesia can cause an accelerated idioventricular rhythm (AIVR), which is associated with higher vagal tone and lower sympathetic activity. We encountered AIVR induced by vagal response to injection-related pain following local anesthetic infiltration into the oral mucosa during general anesthesia. A 48-year-old woman underwent extraction of a residual tooth root from the left maxillary sinus under general anesthesia. Routine preoperative electrocardiogram (ECG) was otherwise normal. Eight milliliters of 1% lidocaine (80 mg) with 1:100,000 epinephrine (80 μg) was infiltrated around the left maxillary molars over 20 seconds using a 23-gauge needle and firm pressure. Widened QRS complexes consistent with AIVR were observed for ∼60 seconds, followed by an atrioventricular junctional rhythm and the return of normal sinus rhythm. A cardiology consultation and 12-lead ECG in the operating room produced no additional concerns, so the operation continued with no complications. AIVR was presumably caused by activation of the trigeminocardiac reflex triggered by intense pain following rapid local anesthetic infiltration with a large gauge needle and firm pressure. Administration of local anesthetic should be performed cautiously when using a large gauge needle and avoid excessive pressure.

Some effects of breath holding and apneic underwater diving on cardiac rhythm in man

1962 ◽  
Vol 17 (3) ◽  
pp. 461-466 ◽  
Author(s):  
C. Robert Olsen ◽  
Darrell D. Fanestil ◽  
Per F. Scholander
Keyword(s):  
Cardiac Arrhythmias ◽  
Cardiac Rhythm ◽  
Sinus Tachycardia ◽  
Normal Sinus Rhythm ◽  
Sinus Bradycardia ◽  
Breath Holding ◽  
Sinus Arrest ◽  
Sinus Arrhythmia ◽  
Normal Sinus ◽  
Idioventricular Rhythm

Man's bradycardic response to simple breath holding was augmented by submersion in water of 27 C and was not prevented by muscular exercise. Cardiac arrhythmias occurred with 45 of 64 periods of apnea in 16 subjects and were more frequent during the dives than during breath holding. These arrhythmias, with the exception of atrial, nodal, and ventricular premature contractions, were inhibitory in type and included sinus bradycardia and arrhythmia, sinus arrest followed by either nodal escape or ventricular escape, A-V block, A-V nodal rhythm, and idioventricular rhythm. T waves frequently became tall and peaked during both breath holding and dives. Prompt return to normal sinus rhythm was the rule with the first breath after surfacing. Sinus tachycardia, sinus arrhythmia, and atrial, nodal, or ventricular premature contractions were seen during recovery. Submitted on October 9, 1961

Metabolic Changes during Recovery in Normothermic versus Hypothermic Patients Undergoing Surgery and Receiving General Anesthesia and Epidural Local Anesthetic Agents 

1998 ◽  
Vol 88 (5) ◽  
pp. 1211-1218 ◽  
Author(s):  
Syrusse Motamed ◽  
Kristine Klubien ◽  
Michael Edwardes ◽  
Louise Mazza ◽  
Franco Carli
Keyword(s):  
Oxygen Consumption ◽  
General Anesthesia ◽  
Local Anesthetic ◽  
Visual Analogue Score ◽  
Sensory Block ◽  
Epidural Block ◽  
Metabolic Changes ◽  
Control Group ◽  
Epidural Blockade ◽  
Anesthetic Agents

Background Mild hypothermia is accompanied by metabolic changes. Epidural local anesthetic agents attenuate the surgical stress response, but it is not known whether they modulate thermal stress. Methods Thirty patients undergoing colorectal surgery, performed by one surgical team, received epidural 0.5% bupivacaine to achieve T3-S5 sensory block. They were then assigned randomly to two groups of 15 patients each. The control or unwarmed group was left to cool during surgery, whereas active warming was used in the warmed group. General anesthesia was induced by thiopentone, vecuronium, fentanyl, nitrous oxide in oxygen, and enflurane. At the end of surgery, both groups received epidural 0.25% bupivacaine to maintain a T5-L3 sensory block. Aural canal (core) and skin surface (15 sites) temperatures; oxygen consumption; pain visual analogue score; and concentrations of epinephrine, norepinephrine, glucose, cortisol, lactate, and free fatty acids in plasma were measured before epidural blockade, 30 min after epidural blockade, at the end of surgery, and for 4 h after surgery. Patients and those measuring the outcomes were unaware of group allocation. Results Core and mean skin temperatures decreased significantly in the control group (P < 0.001) but not in the warmed group. Catecholamine concentrations in plasma decreased significantly after epidural block, and although concentration of epinephrine in plasma increased from baseline sharply in the control group at the end of surgery (P = 0.004), it decreased in the warmed group (P = 0.007). During recovery, there was no difference between the two groups for norepinephrine concentrations in plasma, body weight-adjusted oxygen consumption, pain visual analogue score, and metabolites. Conclusions The postoperative metabolic changes obtained with epidural block were similar except for an attenuated concentration of epinephrine in normothermic patients compared with those who were mildly hypothermic.

Abstract 14912: Sotalol-induced Wide Complex Rhythm: What is the Mechanism?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Albert J Rogers ◽  
Paul J Wang ◽  
Nitish Badhwar
Keyword(s):  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Conduction Time ◽  
Autonomic Tone ◽  
Normal Sinus ◽  
Typical Atrial Flutter ◽  
Atrial Conduction Time ◽  
Idioventricular Rhythm ◽  
History Of

Introduction: Delta waves associated with atrioventricular accessory pathways (APs) may manifest with autonomic tone, heart rate, and rhythm changes. Rarely, drugs like sotalol can block AV nodal conduction, revealing latent WPW, one treatable cause of sudden death. Case report: A 38-year-old man was admitted for sotalol loading due to frequent typical atrial flutter and SVT and a desire to avoid catheter ablation. He had a history of cardiac arrest with adenosine and tachycardia-induced cardiomyopathy. After recovery, cardiac MRI showed a normal heart without scar. Admission 12-lead ECG ( Figure A ) revealed normal sinus rhythm without other abnormality. With administration of sotalol, the patient developed a wide complex rhythm ( Figure B ). Interpretation of the rhythm indicated presence of a latent AP and a repeat ECG ( Figure C ) confirmed manifest preexcitation. After consenting to electrophysiology study, the patient developed a short RP tachycardia ( Figure D ) which terminated with Valsalva. The patient underwent successful catheter ablation of the pathway located at the anterior floor of the coronary sinus body and the cavotricuspid isthmus. Discussion: The differential diagnosis for a wide complex rhythm in this setting includes rate-related aberrancy, idioventricular rhythm, phase 4 aberrancy, and preexcitation from an AP. Shortened and consistent PR intervals in the tracing lead to preexcitation as the only possible mechanism. APs that are capable of anterograde conduction but are not manifest in sinus rhythm are termed latent APs. Conditions that may cause this phenomenon include opposite autonomic effects on the AP and the AV node, increased atrial conduction time, or concealed retrograde conduction into the AP. Sotalol typically increases the retrograde effective refractory period of the AP but has variable anterograde effect. Sotalol has not previously been reported to reveal a latent AP but may have acted through one of the stated mechanisms.

scholarly journals Palatal Necrotic Ulcer Following Local Anesthesia: A Rare Complication

2020 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Local Anesthesia ◽  
Local Anesthetic ◽  
Hard Palate ◽  
Rare Complication ◽  
Tissue Ischemia ◽  
Anesthetic Agents ◽  
Uncommon Condition ◽  
The Right ◽  
Local Anesthetic Infiltration

The everyday practice of dentistry relies heavily on achieving adequate local anesthesia. Even though the safety record of local anesthetic agents is high, complications do occur. Palate is a favorable site for soft-tissue lesions. Various factors such as direct effects of the drug, blanching of the tissues during injection, relatively poor blood supply, and reactivation of the latent forms of herpes can all promote to tissue ischemia and a lesion in the palate. Among various complications, anesthetic necrotic ulcer is a rare and uncommon condition occurring mostly in the hard palate possibly after a local anesthetic infiltration. We report a case of palatal ulceration in a female patient after the administration of a local anesthetic to the right posterior hard palate and follow-up

Local Anesthetic Injection Before Incision Decreases General Anesthesia Requirements in Pediatric Trigger Thumb Release

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Elaina E. Lin ◽  
Faris Z. Fazal ◽  
Matthew F. Pearsall ◽  
Divya Talwar ◽  
Hannah Chang ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Local Anesthetic ◽  
Trigger Thumb ◽  
Local Anesthetic Injection

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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