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Figure 1.; Initial appearance of arrhythmia on the anesthesia monitor. Patient's baseline normal sinus rhythm converting to wide-complex rhythm with a rate in the 90s. This occurred after administration of neuromuscular blockade reversal agents.
Jonathan D. Rizner,
 Heather L. Bartlett, and
 Robert E. Shaw
Figure 1.
Figure 1.

Initial appearance of arrhythmia on the anesthesia monitor. Patient's baseline normal sinus rhythm converting to wide-complex rhythm with a rate in the 90s. This occurred after administration of neuromuscular blockade reversal agents.

Figure 2.; Twelve-lead electrocardiogram (EKG) upon arrival to the postanesthesia care unit. Initial EKG showing the patient's baseline normal sinus rhythm with rate in the 110s.
Jonathan D. Rizner,
 Heather L. Bartlett, and
 Robert E. Shaw
Figure 2.
Figure 2.

Twelve-lead electrocardiogram (EKG) upon arrival to the postanesthesia care unit. Initial EKG showing the patient's baseline normal sinus rhythm with rate in the 110s.

Figure 3.; Twelve-lead electrocardiogram (EKG) in the postanesthesia care unit after recurrence of arrhythmia. EKG obtained after wide complex rhythm recurred, showing wide complex rhythm with a rate in the 90s.
Jonathan D. Rizner,
 Heather L. Bartlett, and
 Robert E. Shaw
Figure 3.
Figure 3.

Twelve-lead electrocardiogram (EKG) in the postanesthesia care unit after recurrence of arrhythmia. EKG obtained after wide complex rhythm recurred, showing wide complex rhythm with a rate in the 90s.

New-Onset Accelerated Idioventricular Rhythm During Dental Rehabilitation
Jonathan D. Rizner BA,
 Heather L. Bartlett MD, and
 Robert E. Shaw MD
Article Category: Case Report
Volume/Issue: Volume 69: Issue 4
Online Publication Date: Dec 19, 2022
DOI: 10.2344/anpr-69-02-13
Page Range: 32 – 36

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Pronounced QT Prolongation During General Anesthesia in a Child with Left Ventricular Noncompaction Cardiomyopathy: A Case Report
Mika Nishikawa DDS,
 Kazumi Takaishi DDS, PhD,
 Marina Takata DDS,
 Osamu Sasajima DDS,
 Shigeki Joseph Luke Fujiwara DDS, PhD,
 Satoru Eguchi DDS, PhD, and
 Shinji Kawahito MD, PhD
Article Category: Brief Report
Volume/Issue: Volume 70: Issue 3
Online Publication Date: Oct 18, 2023
DOI: 10.2344/anpr-70-02-12
Page Range: 137 – 139

, and a defibrillator was prepared in the operating room because QT prolongation has been associated with life-threatening arrythmias like torsade de pointes. After inserting a 22-gauge cannula into a vein of the left forearm, the patient was induced using remifentanil (0.2 μg/kg/min), thiamylal (150 mg), and rocuronium (30 mg), and general anesthesia was maintained with sevoflurane (2%), air (2 L/min), oxygen (1 L/min), and remifentanil (0.1–0.2 μg/kg/min). Local infiltration anesthesia was performed using 1.8 mL of 2% lidocaine with 1:73,000 epinephrine

Cardiovascular Safety and Hemostatic Efficacy of Topical Epinephrine in Children Receiving Zirconia Crowns
Afsoon Fazeli DDS, MSD,
 Travis M. Nelson DDS, MSD, MPH,
 Mir Sohail Fazeli MD, PhD,
 Yvonne S. Lin PhD, and
 JoAnna Scott PhD
Article Category: Research Article
Volume/Issue: Volume 68: Issue 3
Online Publication Date: Oct 04, 2021
DOI: 10.2344/anpr-68-02-05
Page Range: 133 – 140

experienced any cardiac arrythmias or other adverse outcomes during the study procedures or following discharge home. Hemostasis Outcomes Figure 2 A and B demonstrates examples of adequate versus inadequate hemostasis. All 13 teeth receiving the experimental treatment reached adequate hemostasis after an average of 2.2 minutes. Meanwhile, only 5 of the 13 teeth receiving the control treatment reached adequate hemostasis after an average of 4.2 minutes during the 5-minute observation period, which was a significant difference

Accelerated Idioventricular Rhythm Following Intraoral Local Anesthetic Injection During General Anesthesia
Kenichi Sato DDS, PhD,
 Yoshihisa Miyamae DDS,
 Miwako Kan DDS,
 Shu Sato DDS,
 Motoi Yaegashi DDS,
 Wakana Sakanoue DDS,
 Hiroyuki Sakai DDS,
 Souhei Sakamoto DDS, and
 Kazuki Vaba DDS
Article Category: Case Report
Volume/Issue: Volume 68: Issue 4
Online Publication Date: Dec 15, 2021
DOI: 10.2344/anpr-68-03-09
Page Range: 230 – 234

sympathetic suppression is greater than parasympathetic. 21 Rocuronium administered alone has shown no effect on heart rate at clinically relevant concentrations. However, when administered at high concentrations (>2 mg/kg) and combined with IV acetylcholine, rocuronium partially inhibits vagally mediated cardiac activity. 23 Sevoflurane does not induce arrythmias by stimulation of the sympathetic nervous system but has been shown to sensitize the heart and reduce the epinephrine concentration at which arrhythmias can be induced. 2 Remifentanil depresses sinus node

Cardiovascular Collapse Associated With Irreversible Cardiomyopathy, Chronic Renal Failure, and Hypertension During Routine Dental Care
Sean Thoms DMD, MS,
 Matthew Cooke DDS, MD, MPH, and
 James Crawford DMD
Article Category: Case Report
Volume/Issue: Volume 63: Issue 1
Online Publication Date: Jan 01, 2016
DOI: 10.2344/0003-3006-63.1.34
Page Range: 34 – 41

within normal limits, ruling out hyperkalemia-induced arrythmias as the cause of the episode. The patient had to undergo surgery to revascularize the dialysis shunt placed in her left forearm; however, she made a full physical and neurological recovery after being discharged from the hospital. Although it has not been decided how she will undergo dental treatment in the future, the safest and most likely option is to have the patient admitted to the hospital and have all remaining dental work completed using moderate/deep sedation or general anesthesia. This