Complete atrioventricular block following etomidate

Combeer, A.

doi:10.1017/s0265021507001032

Cited by 8 publications

(3 citation statements)

References 4 publications

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“…In our case, the patient similarly reverted to sinus rhythm after giving etomidate, making this the third case being reported for the anti-arrhythmic property of etomidate converting VT to sinus rhythm. This anti-arrhythmic effect may be related to its AV blocking effect on the heart, which can be seen in another case of a 79-year-old woman with a psychiatric illness, who was undergoing an electro- convulsive therapy, and had subsequently developed severe transient bradycardia with transient complete heart block as soon as she was treated by etomidate during the induction phase of the anesthesia [6]. A similar blocking effect was reported by Van Den et al [7].…”

Section: Discussionmentioning

confidence: 94%

Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

et al. 2020

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This case is of a 76-year-old man with a known history of hypertension, type 2 diabetes mellitus, and ischemic heart disease, who presented to our department with chest pain and palpitations. His electrocardiogram showed a ventricular tachycardia (VT), but fortunately our patient was hemodynamically stable. A trial of adenosine was given to convert the patient’s heart back to sinus rhythm, but was unsuccessful and the rhythm remained as VT. Soon after, the patient suddenly became hemodynamically unstable as his blood pressure acutely declined; thus, the decision to perform a direct current cardioversion was taken. Bearing in mind that the patient was still awake, he was given 10 mg of intravenous etomidate as a pre-procedural sedative. During the time it took to prepare for the procedure, the patient’s rhythm reverted from VT to a regular sinus rhythm, raising his blood pressure back to normal and achieving hemodynamic stablility, negating the need of any electrical or chemical cardioversion. Our patient was then handed over to the cardiology team for an emergency percutaneous coronary intervention procedure and an implantable cardioverter-defibrillator procedure, both of which were successful. Etomidate was used in this case for the purpose of sedation, and as luck would have it, it seems that it had also incidentally reverted the arrhythmia back to normal.

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Section: Discussionmentioning

confidence: 94%

Etomidate Shows Prospect as an Anti-Arrhythmic Drug Conferring Safe Sedation and Sinus Conversion Simultaneously

et al. 2020

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“…60 Finally, there are rare case reports of complete atrioventricular block or other bradyarrhythmias. 63 For these reasons, the prescriber must exercise caution and weigh the risk-benefit ratio when using etomidate as an induction agent. Dexmedetomidine.…”

Section: Drug Overviewmentioning

confidence: 99%

Editor’s Choice-The cardiovascular implications of sedatives in the cardiac intensive care unit

Zakaria

Kwong

Sevransky

et al. 2017

European Heart Journal: Acute Cardiovascular Care

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Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine. Additionally, we outline the use of opioids and their role in potentiating other sedatives. We note that some sedatives are associated with increased delirium rates, and emphasize that judicious strategies minimizing sedative use are associated with decreases in morbidity and mortality. We also discuss standardized sedation assessment scales and highlight the importance of sedation weaning. Finally, we offer recommendations for sedation use during therapeutic hypothermia, and discuss the use of adjuvant neuromuscular blocking agents.

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“…16,21 Succinylcholine has been implicated in many instances and the effects can be countered by pretreatment with an anticholinergic agent and, in resistant cases, using a different relaxant. The induction agent and the relaxant can also cause hypotension and bradycardia or arrythmias in susceptible individuals.…”

Section: Cardiovascular Changes During Ectmentioning

confidence: 99%