Professional Documents
Culture Documents
Perioperative Cardiac Dysrrhythmias Presentation Final
Perioperative Cardiac Dysrrhythmias Presentation Final
Perioperative Cardiac Dysrrhythmias Presentation Final
FORMAT
INTRODUCTION
INTRODUCTION
DEFINITION Abnormal cardiac rate or rhythm - Asymptomatic/Symptomatic/lethal
- In a multicenter study with 17,201 patients 70.2% of cases had dysrrhythmias during cardiac or noncardiac surgery combined,1.6% were treated >90% of cases had dysrrhythmias during cardiac surgery alone
1) Alteration of Automaticity
2) Triggered Activity
A Maximum diastolic potential (K+ conductance) - Ach eg. Vagal manuevres - Hypoxia/Hypokalaemia
B Slope of phase 4 (Na+ leak) - Catecholamines eg. pain - Ach C Threshold of Action Potential
TRIGGERED ACTIVITY Defn: Action Potential(AP) which initiates membrane potential oscillations(afterdepolarisation) during late phase 2 or Phase 3 or Phase 4. When the membrane potential oscillations reach threshold potential a new AP is formed. aetiology : intracellular calcium overload
( Digitalis toxicity, long QT syndrome)
Defn: There is failure of successful conduction of impulse along normal pathway. Aetiology : - Reduction in tissue excitability - Abnormalities of gap junctions btn cells
Defn: Conduction of an impulse along an abnormal tract Tract maybe anatomical-(WPW) or functional-(SVTA)
3 Conditions to be satisfied
1) CVS abnormality Preexisting cardiac disease eg. MI - Pulmonary/Coronary thrombosis 2) Respiratory abnormality : Tension pneumothorax
3) CNS abnormality : Intracranial diseases esp. SAH may show ECG abnormalities such as Q waves, ST segment changes, QT interval changes, U waves
4) Aging Degenerative changes in atrial anatomy
Technique GA / CNAB Direct laryngoscopy and tracheal intubation - commonest cause Hypoxia/Hypercarbia/Acidosis Hypothermia/Hyperthermia Hypovolaemia Central venous cannulation Pressure from fingers can stimulate carotid
sinus reflexes during jugular venous cannul.
2) Dental surgery Profound stimulation of both parasympathetic and sympathetic nervous systems 3) Cardiac surgery Retraction of beating heart - Taking sutures over the right atrium - Damage to conduction pathway by surgical incision - Immediate period following release of aortic cross clamp
BRADYDYSRRHYTHMIAS Defn: Heart rate < 60bpm and inadequate for clinical condition Origin SA node (examples) / AV node(examples)
MANAGEMENT OF BRADYDYSRRHYTHMIAS
TACHYDYSRRHYTHMIAS Defn: Heart rate > 100 bpm Classification based on: 1. Appearance of QRS Complexes Narrow(<0.12sec) - Broad(>0.12 sec) 2. Rhythm Regular/ irregular
MANAGEMENT OF TACHYDYSRRHYTHMIAS
ANAESTHETIC CONSIDERATION
ECG monitoring All patients - Lead 11 and V5 Routine measures intraop Airway patent eg. SAB - Breathing: Adequate ventilation and oxygenation - Cardiac history/pathology reevaluation - Depth of anaesthesia adequate - Electrolytes and ABGs optimum - Temperature Specific therapy depends on type of dysrrhythmia
CONCLUSION
Most perioperative dysrrhythmias are benign without significant haemodynamic consequences. However symptomatic patients whose dysrrhythmias can evolve to lifethreatening ones should be treated with anti-dysrrhythmic drugs or electrotherapy promptly. Finally, anti-dysrrhythmic drugs can also cause dysrrhythmias and often times the anaesthetist in an attempt to treat perioperative dysrrhythmias causes iatrogenesis and as such the knowledge of the physiology of cardiac rhythm, pathogenesis of dysrrhythmias, anaesthetic pharmacology and risk to benefit of anti-dysrrhythmic drugs are mandatory.
ACKNOWLEDGEMENT
Dr Baddoo Dr Djagbletey
THANK YOU