In article <003901be8998$6a883be0$56dbac3e@default>, Simon Carley
<[log in to unmask]> writes
>
>>Dr G Ray wrote
>>>By co-incidence we had a male >70 with VT & chest pain
>>>Apparently cardioversion on induction happens but I am not sure how often,
>>Presumably vagal stimulation (due to sux and tickling his oropharynx)?
>>But then this should only work with broad complex tachycardias arising
>>from a supraventricular focus with aberrant conduction (ventricles have
>>few Acetyl Choline receptors). Did your man have BBB on his post-
>>induction 12-lead?
>>
>No it was definately VT. Concordance in chest leads, weird axis and capture
>beats seen.
>
Did you use propofol?. One of the listed recognized side-effects of
propofol is bradycardia.
If it was an RSI for an unstable VTach I suspect you may have used
etomidate (for its relative cardiostability.)
However, I've done an RSI (given a history of active vomiting), using
propofol on a cardiovascularly stable 70-odd year old lady in a SVT
resistant to medical management.
As I gave the propofol (before the sux) .. I heard the monitor 'beep'
rate slow .. and she dropped to a heart rate of 36, spontaneously
recovering to a normal sinus rhythm, rate 70-odd. (I didn't give
atropine .. as I still was securing the airway with sux / tube, and it
recovered before I would have had time to give atropine). {Question ..
given the history of SVT .. would you have given atropine /
glycopyrrulate if the heart rate had stayed around 40??? ... assuming a
palpable major pulse?}
Sux and tube went in as I needed to secure the airway.
Medical House Officer who was going to cardiovert looked a little
disappointed that they weren't going to get to play with electricity :)
It could have been a temporal co-incidence ...but she then was getting
light while still not breathing .. so I gave her a further 30 mg of
propofol as a bolus.. and again she had a transient bradycardia, making
me suspect it was the propofol, rather than a temporal coincidence or
secondary to vagal stimulation from the cricoid pressure.
Anyone else had this happen, or can advise if this is a likely reason?
--
Barry Salkin (SHO Anaesthetics / ITU).
To reply to a news-post, delete the x from medxleg - its an antispam measure.
Private e-mail shouldn't have the x present, unless I'm replying to a news-post
of yours, in which case you'll still have to delete the x from the medxleg of
the reply address..
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