An 80-year-old woman with chronic
atrial flutter/fibrillation, and
chronic renal failure underwent ileocecal resection. The preoperative electrocadiogram showed normal QT interval. Temporary pacemaker
catheter was inserted for sinus arrest (5-6 sec) the day before operation.
Anesthesia was induced with
remifentanil 0.5 micro x kg(-1) min(-1),
thiamylal 125 mg, and
rocuronium 30 mg after intravenous
atropine sulfate 0.5 mg. Because the heart rate was increased with
atropine sulfate, the pacemaker was not started.
Anesthesia was then maintained with intravenous
remifentanil and
sevoflurane-air-
oxygen. Just after induction of
anesthesia, sinus
bradycardia occurred, and 9 minutes after tracheal intubation, ECG suddenly showed
torsade de pointes (TdP) and the arterial blood pressure decreased leading to
asystole. We immediately started
cardiopulmonary resuscitation, and TdP stopped spontaneously within 1 minute. We started pacemaker (VVI, 60 beats x min(-1)) and
intravenous injection of
lidocaine, and TdP did not recur. In this case, TdP seemed to have occurred because of
bradycardia-induced abnormal QT prolongation. This should be considered the risk of lethal
arrhythmia in patients with severe
bradycardia including TdP.