Miller Anestesia

betabloqueantes (v.

fig. 32-27 )

. El paciente comenzó a delirar y a desa-

rrollar disnea. Se trató con diuréticos por vía intravenosa y una infu-

sión lenta de concentrados de hematíes.Veinticuatro horas después de

la cirugía, los cambios isquémicos electrocardiográficos regresaron

hasta valores casi normales, aunque la troponina sérica T aumentó hasta 0,64ng/ml y se mantuvo elevada durante otros 5 días.

Este caso singular demuestra que el IM postoperatorio

puede aparecer como consecuencia de una isquemia con des-

censo del ST inducida por un estrés prolongado, en presencia

de una coronariopatía estable, con una oclusión coronaria cró

nica total de una arteria y sin ruptura de la placa de ate-

roma.

Bibliografía

1. Kligfield P, Gettes LS, Bailey JJ, et al: Recommenda-

tions for the standardization and interpretation of the

electrocardiogram: part I: The electrocardiogram and

its technology: A scientific statement from the Ame-

rican Heart Association Electrocardiography and

Arrhythmias Committee,Council on Clinical Cardio-

logy; the American College of Cardiology Founda-

tion; and the Heart Rhythm Society: Endorsed by the

International Society for Computerized Electrocar-

diology. Circulation 115:1306–1324, 2007.

2. Slogoff S, Keats AS, David Y, Igo SR: Incidence of

perioperative myocardial ischemia detected by diffe-

rent electrocardiographic systems. Anesthesiology

74:1171–1172, 1991.

3. Thys DM, Kaplan JA: The ECG in Anesthesia and

Critical Care. New York, Churchill Livingstone, 1987.

4. Bazaral MG, Norfleet EA: Comparison of CB

and V

leads for intraoperative electrocardiographic monito-

ring. Anesth Analg 60:849–853, 1981.

5. Mason RE, Likar I: A new system of multiple-lead

exercise electrocardiography.Am Heart J 71:196–205,

1966.

6. Krucoff MW, Loeffler KA, Haisty WK Jr, et al: Simul-

taneous ST-segment measurements using standard

and monitoring-compatible torso limb lead place-

ments at rest and during coronary occlusion. Am J

Cardiol 74:997–1001, 1994.

7. London MJ: Validation testing of the SEER real-time

digital Holter monitor. J Cardiothorac Vasc Anesth

10:497–501, 1996.

8. Dodds TM, Delphin E, Stone G, et al: Detection of

perioperative myocardial ischemia using Holter with

real-time ST segment analysis. Anesth Analg 67:890–

893, 1988.

9. Romhilt DW, Bloomfield SS, Chou TC, Fowler NO:

Unreliability of conventional electrocardiographic

monitoring of arrhythmia detection in coronary care

units. Am J Cardiol 31:457–461, 1973.

10. Chiang CM, Jenkins JM, DiCarlo LA, et al: Real-time

arrhythmia identification from automated analysis of

intraatrial and intraventricular electrograms. Pacing

Clin Electrophysiol 16:223–227, 1993.

11. Igel DA,Wilkoff BL: Automated ventricular tachyarr-

hythmia recognition: A combination of cycle length

and nonlinear dynamics measurements. J Cardiovasc

Electrophysiol 8:388–397, 1997.

12. Drew BJ, Califf RM, Funk M, et al: Practice standards

for electrocardiographic monitoring in hospital set-

tings: An American Heart Association Scientific Sta-

tement from the Councils on Cardiovascular Nursing,

Clinical Cardiology, and Cardiovascular Disease in

the Young. Circulation 110:2721–2746, 2004.

13. Heintz KM, Hollenberg SM: Perioperative cardiac

issues: Postoperative arrhythmias. Surg Clin North

Am 85:1103–1114, 2005.

14. Mahla E, Rotman B, Rehak P, et al: Perioperative ven-

tricular dysrhythmias in patients with structural heart

disease undergoing noncardiac surgery.Anesth Analg

86:16–21, 1998.

15. Mathew JP, Fontes ML, Tudor IC, et al: A multicenter

risk index for atrial fibrillation after cardiac surgery.

Investigators of the Ischemia Research and Education

Foundation; Multicenter Study of Perioperative

Ischemia Research Group. JAMA 291:1720–1729,

2004.

16. Atlee JL 3rd, Rusy BF: Ventricular conduction times

and AV nodal conductivity during enflurane anesthe-

sia in dogs. Anesthesiology 47:498–503, 1977.

17. Kroll DA, Knight PR: Antifibrillatory effects of vola-

tile anesthetics in acute occlusion/reperfusion arr-

hythmias. Anesthesiology 61:657–661, 1984.

18. Green DH, Townsend P, Bagshaw O, Stokes MA:

Nodal rhythm and bradycardia during inhalation

induction with sevoflurane in infants: A comparison

of incremental and high-concentration techniques.Br

J Anaesth 85:368–370, 2000.

19. Owczuk R, Wujtewicz MA, Sawicka W, et al: The

Influence of desflurane on QTc interval.Anesth Analg

101:419–422, 2005.

20. Reiz S, Nath S: Cardiotoxicity of local anesthetic

agents. Br J Anaesth 58:736–746, 1986.

21. Rosenblatt MA, Abel M, Fischer GW, et al: Successful

use of a 20% lipid emulsion to resuscitate a patient

after a presumed bupivacaine-related cardiac arrest.

Anesthesiology 105:217–218, 2006.

22. Weinberg G: Lipid infusion resuscitation for local

anesthetic toxicity: Proof of clinical efficacy.Anesthe-

siology 105:7–8, 2006.

23. Edwards R, Winnie AP, Ramamurthy S: Acute hypo-

capneic hypokalemia: An iatrogenic anesthetic com-

plication. Anesth Analg 56:786–792, 1977.

24. Samuel MA: The brain-heart connection. Circulation

116:77–84, 2007.

25. Angelini L, Feldman MI, Lufschonowski R, Leachman

RD: Cardiac arrhythmias during and after heart

surgery: Diagnosis and management. Prog Cardio-

vasc Dis 16:469–495, 1974.

26. Alexander JP: Dysrhythmia and oral surgery. Br J

Anaesth 43:773–778, 1971.

27. Dobrzynski H, Boyett MR, Anderson RH: New

insights into pacemaker activity: Promoting unders-

tanding of sick sinus syndrome.Circulation 115:1921–

1932, 2007.

28. diMarco JP, Sellers TD, Lerman BB, et al: Diagnostic

and therapeutic use of adenosine in patients with

supraventricular tachyarrhythmias.J Am Coll Cardiol

6:417–425, 1985.

29. Bushman GA: Clinical correlates of dysrhythmias

requiring an esophageal ECG for accurate diagnosis

in patients with congenital heart disease. J Cardiotho-

rac Anesth 3:290–294, 1989.

30. Lim SH, Anantharaman V, Teo WS, et al: Comparison

of treatment of supraventricular tachycardia by Val-

salva maneuver and carotid sinus massage. Ann

Emerg Med 31:30–35, 1998.

31. Camm AJ, Garratt CJ: Adenosine and supraventricu-

lar tachycardia. N Engl J Med 325:1621–1629, 1991.

32. DiMarco JP, Miles W, Akhtar M, et al: Adenosine for

paroxysmal supraventricular tachycardia: Dose

ranging and comparison with verapamil. Assessment

in placebo-controlled, multicenter trials: The Adeno-

sine for PSVT Study Group. Ann Intern Med

113:104–110, 1990.

33. Balser JR: The rational use of intravenous amiodarone

in the perioperative period. Anesthesiology 86:974–

987, 1997.

34. Balser JR, Martinez EA, Winters BD, et al: Beta-adre-

nergic blockade accelerates conversion of postopera-

tivesupraventriculartachyarrhythmias.Anesthesiology

89:1052–1059, 1998.

35. Eldor J, Frankel DZ: Use of low-dose neostigmine

intravenously in the treatment of supraventricular

tachycardia: An immediate bradycardic effect. Resus-

citation 18:103–110, 1989.

36. Basta M, Klein GJ, Yee R, et al: Current role of phar-

macologic therapy for patients with paroxysmal

supraventricular tachycardia. Cardiol Clin 15:587–

597, 1997.

37. Altamura G, Bianconi L, Toscano S, et al: Transcuta-

neous cardiac pacing for termination of tachyarrhyth-

mias. Pacing Clin Electrophysiol 13:2026–2030,

1990.

38. Hood RE, Shorofsky SR: Management of arrhythmias

in the emergency department. Cardiol Clin 24:125–

133, 2006.

39. Morady F: Catheter ablation of supraventricular arr-

hythmias: State of the art. J Cardiovasc Electrophysiol

15:124–139, 2004.

40. Niebauer MJ, Chung MK: Management of atrial

flutter. Cardiol Rev 9:253–258, 2001.

41. Sedrakyan A, Treasure T, Browne J, et al: Pharmaco-

logic prophylaxis for postoperative atrial tachyarr-

hythmia in general thoracic surgery: Evidence from

randomized clinical trials. J Thorac Cardiovasc Surg

129:997–1005, 2005.

42. Ellenbogen KA,Stambler BS,Wood MA,et al: Efficacy

of intravenous ibutilide for rapid termination of atrial

fibrillation and atrial flutter: A dose-response study.

J Am Coll Cardiol 28:130–136, 1996.

43. Chapman MJ, Moran JL, O’Fathartaigh MS, et al:

Management of atrial tachyarrhythmias in the criti-

cally ill: A comparison of intravenous procainamide

and amiodarone. Intensive Care Med 19:48–52, 1993.

44. Mayson SE, Greenspon AJ, Adams S, et al: The chan-

ging face of postoperative atrial fibrillation preven-

tion:A review of current medical therapy.Cardiol Rev

15:231–241, 2007.

45. Page RL, Kerber RE, Russell JK, et al: Biphasic versus

monophasic shock waveform for conversion of atrial

fibrillation: The results of an international randomi-

zed, double-blind multicenter trial. J Am Coll Cardiol

39:1956–1963, 2002.

46. O’Neill MD, Jais P, Hocini M, et al: Catheter ablation

for atrial fibrillation. Circulation 116:1515–1523,

2007.

47. Naccarelli GV,Dorian P,Hohnloser SH,et al: Prospec-

tive comparison of flecainide versus quinidine for the

treatment of paroxysmal atrial fibrillation/flutter: The

Flecainide Multicenter Atrial Fibrillation Study

Group. Am J Cardiol 77:53A, 1996.

48. Gallik DM, Kim SG, Ferrick KJ, et al: Efficacy and

safety of sotalol in patients with refractory atrial fibri-

llation or flutter. Am Heart J 134:155–160, 1997.

49. Opolski G, Stanislawska J, Górecki A, et al: Amioda-

rone in restoration and maintenance of sinus rhythm

in patients with chronic atrial fibrillation after unsuc-

cessful direct-current cardioversion. Clin Cardiol

20:337–340, 1997.

50. Stambler BS,Wood MA,Ellenbogen KA,et al: Efficacy

and safety of repeated intravenous doses of ibutilide

for rapid conversion of atrial flutter or fibrillation.

Ibutilide Repeat Dose Study Investigators.Circulation

94:1613–1621, 1996.

51. Donahue TP, Conti JB: Atrial fibrillation: Rate control

versus maintenance of sinus rhythm. Curr Opin

Cardiol 6:46–53, 2001.

52. Haldemann G, Sehaer H: Haemodynamic effects of

transient atrioventricular dissociation in general

anesthesia. Br J Anaesth 44:159–162, 1972.

53. Oupadia P, Ramaswamy K: Images in clinical medi-

cine.“R-on-T” phenomenon. N Engl J Med 338:1812,

1998.

54. Mittal S, Ayati S, Stein KM, et al: Comparison of a

novel rectilinear biphasic waveform with a damped

Electrocardiografía

1151

Sección III

Control de la anestesia