Electrocardiographic Changes after Neostigmine-Atropine Mixture

Lock, Giovani; Fialho, Guilherme Loureiro; Lima, Daniel Castro; Almeida, Maria Cristina Simões de

doi:10.4172/2155-6148.1000188

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…Our assumption is supported by the fact that, although generally considered safe, this anticholinesterase-anticholinergic combination may have a potential proarrhythmic effect. (7) In order to further investigate the possible cause of this substantial but, fortunately, timely managed cardiovascular event in our patient, we have performed a literature review. Several relevant electronic databases were systematically searched using a combination of the following keywords: "neuromuscular blockade reversal", "atropine and neostigmine", "ventricular tachycardia" and "hypertensive crisis".…”

Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review

Jovanovic¹,

Trailovic²,

Mutavdžić³

et al. 2022

Medicinska istraživanja

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Introduction: Neuromuscular blockade reversal may provoke cardiovascular events. We present the case of a middle-aged, vascular patient in whom ventricular tachycardia and hypertensive crisis occurred immediately after the initiation of neuromuscular blockade reversal. Patient Review: A 56-year-old man was admitted to our institution for emergency surgical treatment of left extremity ischemia. Besides hypertension, the patient's medical history was negative for any other significant acute or chronic diseases. Routine preoperative analyzes, ECG, and echocardiography showed normal findings. The patient underwent urgent trans popliteal thrombectomy under general endotracheal anesthesia. Immediately following the initiation of neuromuscular blockade reversal, with a diluted mixture of atropine and neostigmine (1 mg/2.5 mg, respectively), ventricular tachycardia and hypertensive crisis developed. Arterial blood gas analyses and electrolyte values were within the reference limits at the moment. Adequate therapeutic measures were undertaken immediately, and sinus rhythm was restored shortly. Later, serial ECG records showed negative T waves in the precordial leads, with an increasing trend of troponin I values (ranging from 0.59 to 5.45 mg/L). Coronary angiography was later performed and revealed a normal coronary angiogram. During the next three days, ischemic ECG alterations showed resolution and the patient was hemodynamically stable. On the fifth postoperative day, the patient was discharged, in good general medical condition. Conclusion: A careful administration of the atropine/neostigmine mixture is advised. Malignant arrhythmias must be recognized and treated promptly by an anesthesiologist, in order to achieve positive treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review

Jovanovic¹,

Trailovic²,

Mutavdžić³

et al. 2022

Medicinska istraživanja

View full text Add to dashboard Cite

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The prevalence of long QT interval in post-operative intensive care unit patients

Pham

Banks

Narotsky

et al. 2015

J Clin Monit Comput

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The severity of patient illnesses and medication complexity in post-operative critically ill patients increase the risk for a prolonged QT interval. We determined the prevalence of prolonged QTc in surgical intensive care unit (SICU) patients. We performed a prospective cross-sectional study over a 15-month period at a major academic center. SICU pre-admission and admission EKGs, patient demographics, and laboratory values were analyzed. QTc was evaluated as both a continuous and dichotomous outcome (prolonged QTc > 440 ms). 281 patients were included in the study: 92 % (n = 257) post-operative and 8 % (n = 24) non-operative. On pre-admission EKGs, 32 % of the post-operative group and 42 % of the non-operative group had prolonged QTc (p = 0.25); on post-admission EKGs, 67 % of the post-operative group but only 33 % of the non-operative group had prolonged QTc (p < 0.01). The average change in QTc in the post-operative group was +30.7 ms, as compared to +2 ms in the non-operative group (p < 0.01). On multivariable adjustment for long QTc as a dichotomous outcome, pre-admission prolonged QTc (OR 3.93, CI 1.93-8.00) and having had an operative procedure (OR 4.04, CI 1.67-9.83) were associated with developing prolonged QTc. For QTc as a continuous outcome, intra-operative beta-blocker use was associated with a statistically-significant decrease in QTc duration. None of the patients developed a lethal arrhythmia in the ICU. Prolonged QTc is common among post-operative SICU patients (67 %), however lethal arrhythmias are uncommon. The operative experience increases the risk for long QTc.

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Effect of Sugammadex on QT/QTc Interval Prolongation when Combined with QTc-Prolonging Sevoflurane or Propofol Anaesthesia

et al. 2013

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Electrocardiographic Changes after Neostigmine-Atropine Mixture

Cited by 4 publications

References 21 publications

Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review

Ventricular tachycardia and hypertensive crisis induced by routine neuromuscular blockade reversal: A case report and literature review

The prevalence of long QT interval in post-operative intensive care unit patients

Effect of Sugammadex on QT/QTc Interval Prolongation when Combined with QTc-Prolonging Sevoflurane or Propofol Anaesthesia

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