Zusammenfassung.
Perioperative Arrhythmien werden häufig beobachtet. Bei immerhin 2,5 % aller perioperativen
Patienten stellen sie eine ernstzunehmende Komplikation dar. In dieser Übersicht wird
zunächst das myokardiale Reizbildungs- und Reizleitungssystem erklärt, dann die spezielle
Ätiologie und Pathophysiologie wichtiger perioperativer Arrhythmien diskutiert, bevor
auf ausgewählte Antiarrhythmika genauer eingegangen wird. Schließlich werden Therapievorschläge
für die häufigsten Arrhythmien vorgestellt.
Perioperative Antiarrhythmic Drug Management.
Perioperative arrhythmias are common. In 2.5 % they result in a severe adverse outcome.
This review discusses the normal physiology of the myocardial conduction system and
the etiology and pathophysiology of the most common perioperative dysrhythmias. Subsequently
some important antiarrhythmic drugs are described and treatment plans for the most
frequent dysrhythmias are presented.
Schlüsselwörter:
Perioperative Arrhythmien - Antiarrhythmikaeinsatz
Key words:
Perioperative dysrhythmias - Antiaarrhythmic drug management
Literatur
- 1
Forrest J, Cahalan M, Rehder K, Goldsmith C, Levy R, Strunin L, Bota W, Bouchek C,
Bucchiara R, Dhamee M, Domino K, Dudman A, Hamilton W, Kampine J, Kotrly K, Maltby J,
Mazloomdoost M, MacKenzie R, Melnick B, Motoyama E, Muir J, Munshi C.
Multicenter study of general anesthesia. II. Results.
Anesthesiology.
1990;
72
262-268
- 2
O'Kelly B, Browner W S, Massie B, Tubau J, Ngo L, Mangano D T.
Ventricular arrhythmias in patients undergoing noncardiac surgery. The Study of Perioperative
Ischemia Research Group.
J Am Med Ass.
1992;
268
217-221
- 3
Bertrand C A, Steiner N V, Jameson A G.
Disturbances of cardiac rhythm during anesthesia and surgery.
J Am Med Ass.
1971;
216
1615-1617
- 4
Mahle E, Rotman B, Rehak P, Atlee J L, Gombotz H, Berger J, List W F, Klein W, Metzler S.
Perioperative ventricular dysrhythmias in patients with structural heart disease undergoing
noncardiac surgery.
Anesth Analg.
1998;
86
16-21
- 5
Atlee J L, Bosnjak Z J.
Mechanisms for cardiac arrhythmias during anesthesia.
Anesthesiology.
1990;
72
347-374
- 6
Bosnjak Z J, Kampine J T.
Effects of halothane, enflurane, and isoflurane on the SA node.
Anesthesiology.
1983;
S8
314
- 7
Johnston R R, Eger E I, Wilson C.
A comparative interaction of epinephrine with enflurane, isoflurane and halothane
in man.
Anesth Analg.
1976;
55
709-712
- 8
Moore M, Weiskopf R, Eger E I.
Arrhythmogenic doses of epinephrine are similar during desflurane for isoflurane anesthesia
in humans.
Anesthesiology.
1993;
79
943-947
- 9
Navarro R, Weiskopf R B, Moore M A.
Humans anesthesized with sevoflurane or isoflurane have similar arrhythmic response
to epinephrine.
Anesthesiology.
1994;
80
545-549
- 10
Koehntop D E, Liao J C, Van Bergen F H.
Effects of pharmacologic alterations of adrenergic mechanisms by cocaine, tropolone,
aminophylline, and ketamine on epinephrine-induced arrhythmias during halothan-nitrous
oxide anesthesia.
Anesthesiology.
1997;
46
83-93
- 11
Dimich I, Lingham R, Narang J.
Esmolol prevents and suppresses arrhythmias during halothane anesthesia in dogs.
Can J Anest.
1992;
39
83-86
- 12
Yasuda I, Hirano T, Ahama K, Fudeta H, Obara S.
Chronotropic effect of succinylcholine and succinylmonocholine on the sinuatrial node.
Anesthesiology.
1982;
57
289-292
- 13
Jacobs H K, Lim S, Salem M R, Rao T LK, Mathu M, Smith B D.
Cardiac electrophysiologic effects of pancuronium.
Anesth Analg.
1985;
64
693-699
- 14
Clayton D.
Asystole associated with vecuronium.
Br J Anesth.
1986;
58
937-938
- 15
Fox E J, Sklar G S, Hill C H.
Complications related to the pressor response to endotracheal intubation.
Anesthesiology.
1977;
47
524-525
- 16
Smith M, Ray C T.
Cardiac arrhythmias, increased intracranial pressure, and the autonomic nervous system.
Chest.
1971;
61
125-133
- 17
Alexander J P.
Dysrhythmia and oral surgery.
Br J Anest.
1971;
43
773-778
- 18
Roth A, Angster R, Forst H.
Begleitmedikation - Notwendigkeit, Nebenwirkungen und Interaktionen in der perioperativen
Phase.
Anaesthesist.
1999;
48
267-283
- 19
Manz M, Mletzko R, Jung W, Lüderitz B.
Electrophysiological and haemodynamic effects of lidocaine and ajmaline in the management
of sustained ventricular tachycardia.
Eur Heart J.
1992;
13
1123-1128
- 20
Grant A.
On the mechanismen of action of antiarrhythmic agents.
Am Heart J.
1992;
123
1130-1136
- 21
Whalley D, Wendt D, Grant A.
Basic concepts in cellular cardiac electrophysiology: part II. block of the ion channels
by antiarrhythmic drugs.
PACE.
1995;
18
1666-1704
- 22
McDonald T, Courtney K, Cusin W.
Use-dependent block of single sodium channels by lidocaine in guinea pig ventricular
mycocytes.
Biophys J.
1989;
55
1261-1277
- 23
Atlee J L.
Perioperative cardiac dysrhythmias: diagnosis and management.
Anesthesiology.
1997;
86
1397-1424
- 24
Kowy P, Levine J, Herre J, Pacifico A, Lindsay B, Plumb V, Janosik D, Kopelman H,
Scheinman M.
Randomized, double-blind comparison of intravenous amiodaron and bretylium in the
treatment of patients with recurrent, hemodynamically destabilizing ventricular tachycardias
or fibrillation.
Circulation.
1995;
92
3255-3263
- 25
Cote P, Bourassa M, Delay J, Janin A, Froment R, David P.
Effects of amiodarone on cardiac and coronary hemodynamics and on myocardial metabolism
in patients with coronary artery disease.
Circulation.
1978;
59
1165-1172
- 26
Gallagher J, Lieberman R, Meranze J, Spielman S, Ellison N.
Amiodarone-induced complications during coronary surgery.
Anesthesiology.
1981;
55
186-188
- 27
McKinnon G, Landymore R, Marble A.
Should oral amiodarone be used for sustained ventricular tachycardia in patients requiring
open heart surgery.
Can J Surg.
1983;
26
355-357
- 28
Navalgund A, Alifimoff J, Jaiymec A, Bleyaert A.
Amiodarone-induced sinus arrest successfully treated with ephedrine and isoproterenol.
Anesth Analg.
1986;
65
414-416
- 29
Levine J, Massumi A, Scheinman M, Winkle R, Platia E, Chilson D, Gomes A, Woosley R.
Intravenous amiodarone for recurrent sustained hypotensive ventricular tachydysrhythmias.
J Am Coll Cardiol.
1996;
27
67-75
- 30
Balser J R.
The rational use of intravenous amiodarone in the perioperative period.
Anesthesiology.
1997;
86
974-987
- 31
Levine J, Michael J, Guamieri T.
Treatment of multifocal atrial tachycardia with verapamil.
N Engl J Med.
1985;
312
21-25
- 32
Atlee J, Hamann S, Brownlee S, Kreigh C.
Conscious state comaprison of the effects of the inhalation anesthetics and diltiazem,
nifedipine, or verapamil on specialized atrioventricular conduction times in spontaneously
beating dog hearts.
Anesthesiology.
1988;
68
19-28
- 33
Atlee J, Bosniak Z, Yeager T.
Effects of diltiazem, verapamil and inhalation anesthetics on electrophysiologic properties
affecting reentrant supraventricular tachycardia in chronically instrumented dogs.
Anesthesiology.
1990;
72
889-901
- 34
Kapur P, Bloor B, Flacke W, Olewine S.
Comparison of cardiovascular response to verapamil during enflurane, isoflurane or
halothane anesthesia in the dog.
Anesthesiology.
1984;
61
156-160
- 35
Prystowsky E N.
Proarrhythmia during drug treatment of supraventricular tachycardia: paradoxical risk
of sinus rhythm and sudden death.
Am J Cardiol.
1996;
78 S8A
35-41
- 36
Freilich A, Tepper D.
Adenosine and its cardiovascular effects.
Am Heart J.
1992;
123
1324-1328
- 37
Camm A, Garrat C.
Adenosine and supraventricular tachycardia.
N Engl J Med.
1991;
325
1621-1629
- 38
Brodsky M, Hwang C, Hunter D, Chen P, Smith D, Ariani M, Johnston W, Alen B, Chun J,
Gold C.
Life-threatening alterations in heart rate after the use of adenosine in arterial
flutter.
Am Heart J.
1995;
130
561-571
- 39
Seller R.
The role of magnesium in digitalis toxity.
Am Heart J.
1971;
82
551-556
- 40
Zwerling H.
Does exogenous magnesium suppress myocardial irritability and tachydysrhythmias in
the nondigitalized patient?.
Am Heart J.
1987;
113
1046-1053
- 41
Iseri L, Freed J, Bures A.
Magnesium deficiency and cardiac disorders.
Am J Med.
1975;
58
837-846
- 42
Iseri L, Chung P, Tobis J.
Magnesium therapy for intractable ventricular tachyarrhythmias in normomagnesiemic
patients.
West J Med.
1983;
138
823-828
- 43
Waldo A, Wells J, Cooper T, McLean W.
Temporary cardiac pacing: application and techniques in the treatment of cardiac arrhythmias.
Prog Cardiovasc Dis.
1981;
23
451-474
- 44
Zoll P, Zoll R, Falk R, Clinton J, Eitel D, Antmann E.
External noninvasive temporary cardiac pacing: clinical trials.
Circulation.
1985;
71
937-944
- 45
Kelly J, Royster R.
Noninvasive transcutaneous pacing.
Anesth Analg.
1989;
69
229-238
- 46
Guamerio M, Furlanello F, Del Greco M, Vergara G, Inama G, Disertori M.
Transesophageal atrial pacing: a first-choice technique in atrial flutter therapy.
Am Heart J.
1989;
117
1241-1251
- 47
Feeley T.
Management of perioperative arrhythmias.
J Cardiothorac Vasc Anesth.
1997;
11S2
10-15
- 48
Morganroth J, Horowitz L N, Anderson J.
Comparative efficacy and tolerance of esmolol to propanolol for control of supraventricular
tachyharrhythmias.
Am J Cardiol.
1985;
56
33F-39F
- 49
Gray J R, Bateman T M, Czer L S.
Esmolol: a new ultrashort-acting beta-adrenergic blocking agent for rapid control
of heart rate in postoperative supraventricular tachyarrhythmias.
J Am Coll cardiol.
1985;
5
1451-1456
- 50
Hill G A, Owens S D.
Esmolol in the treatment of multifocal atrial tachycardia.
Chest.
1992;
101
1726-1728
- 51
Dimarco J P, Sellers T D, Berne T D.
Adenosine: Electrophysiologic effects and therapeutic use for terminating paroxysmal
supraventricular tachycardia.
Circulation.
1983;
68
1254-1263
- 52
Stemp L I, Roy W L.
Adenosine for the cardioversion of supraventricular tachycardia during general anaesthesia
and open heart surgery.
Anesthesiology.
1992;
76
849-852
- 53
Raickenberger R L, Prystowsky E N, Heger J J.
Effects of intravenous and chronic oral verapamil administration in patients with
supraventricular tachyarrhythmias.
Circulation.
1980;
62
996-999
- 54
Platia E V, Michelson E L, Porterfield J K.
Esmolol versus verapamil in the acute treatment of atrial fibrillation or atrial flutter.
Am J Cardiol.
1989;
63
925-929
- 55
Das G, Ferris J.
Esmolol in the treatment of supraventricular tachyarrhythmias.
Can J Cardiol.
1988;
4
177-180
- 56
Sung R, Tan H, Karagounis L, Hanyok J, Falk R, Platia E, Das G, Hardy S.
Intravenous sotalol for the termination of supraventricular tachycardia and atrial
fibrillation and flutter: a multicenter, randomized, double-blind, placebo-controlled
study.
Am Heart J.
1995;
129
739-748
- 57
Haldemann G, Schaer H.
Hemodynamic effects of transient atrioventricular dissication in general anaesthesia.
Br J Anaesth.
1972;
44
159-162
- 58
Van Dantzig J M, Koster R W, Biervliet J D.
Treatment with esmolol of ventricullar fibrillation unresponsive to lidocain and procainamide.
J Cardiothorac Vasc Anesth.
1991;
5
600-603
Dr. med. Christoph Strom
Klinik für Anaesthesiologie
Klinikum Innenstadt der LMU
Nußbaumstraße 7
80336 München
eMail: c-k-strom@t-online.de
