Bradycardia after dexamethasone for postoperative nausea and vomiting prophylaxis during induction of anaesthesia

Abstract

respiration, and no patient experienced oxygen desaturation to ,92%. Adequate light sedation before awake insertion of the ILMA was achieved with total midazolam and fentanyl doses ranging from 3 to 6 [mean 4.4 (0.8)] and 0.1 to 0.3 [mean 0.16 (0.6)] mg, respectively. No patient recalled experiencing discomfort during the procedure when questioned after operation.We obtained good results with awake insertion of a size 3.5 air-Q TM ILMA device followed by tracheal intubation using the device as a conduit in morbidly obese patients (n¼20) undergoing bariatric surgery. This ILMA device is designed for easier insertion. It has a curvature approximate to that of the upper oropharyngeal airway and a wider (anterior -posterior diameter¼15 mm) and shorter airway conduit than previous models. 4 5 It has an easily removable airway adapter with no grill in the ventilating orifice, which may further facilitate insertion and placement (Fig. 1C).In conclusion, the technique we describe may be a viable alternative to mask ventilation and direct laryngoscopy for safe airway management in morbidly obese patients. Further studies and detailed comparison with results of other techniques may be warranted.

Acute Symptomatic Sinus Bradycardia in High-Dose Methylprednisolone Therapy in a Woman With Inflammatory Myelitis: A Case Report and Review of the Literature

“…4,5 Bradycardia is generally associated with high-dose intravenous corticosteroid administration, but some cases after low-dose intravenous and oral corticosteroid therapy have been reported. 11,15,17,18 In a review of the literature by Stroeder et al, 19 93 cases of bradycardia attributed to PST have been reported, from 1970 to 2014. Other cases, not included in this work, have been reported 12-14,17,18 reaching a total amount of 105 cases of bradycardia consequently to corticosteroids administration (11 case reports, 6 case series, 2 prospective studies, and 1 retrospective study).…”

Maternal Bradycardia Associated with Betamethasone Administration During Pregnancy

“…Taylor and Gaco reported a symptomatic sinus bradycardia which was induced by a five-day course of high dose oral prednisolone in a multiple sclerosis patient [7]. Marinov et al reported a case of sinus bradycardia after a single dose of intravenous dexamethasone for post-operative nausea and vomiting prophylaxis during anesthesia induction [8]. Others have reported sinus bradycardia induced by intravenous methylprednisolone [9, 10].…”

Bradycardia Associated with Steroid Use for Laryngeal Edema in an Adult: A Case Report and Literature Review

“…To our knowledge, there are only two case reports of dexamethasone-induced cardiac dysrhythmia in adult patients. One report described bradycardia in an adult female who received a 4 mg dose of intravenous dexamethasone upon induction of anesthesia for prophylaxis of postoperative nausea and vomiting [16]. The other case report describes frequent premature ventricular contractions (PVCs) in an adult female receiving dexamethasone postoperatively following cardiopulmonary bypass for aortic and mitral valve replacement [17].…”

“…To our knowledge there are only two case reports in the literature describing bradycardia following short term intravenous dexamethasone use in adult females. In both cases, bradycardia was self-limiting and resolved after steroid discontinuation [16, 17]. …”