Editorial Type:
Article Category: Case Report
 | 
Online Publication Date: Jan 01, 2018

General Anesthetic Management of a Patient With Hypertrophic Cardiomyopathy for Oral Surgery: Did Digitalis Contribute to Bradycardia?

DDS, PhD,
DDS,
MD,
MD, PhD,
MD,
DDS, PhD,
MD, PhD, and
MD, PhD
Page Range: 192 – 196
DOI: 10.2344/anpr-65-03-12
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Stabilization of circulatory dynamics is a critical issue in the anesthetic management of patients with hypertrophic cardiomyopathy (HCM). In this report, we managed general anesthesia for a 74-year-old male patient with nonobstructive HCM who developed circulatory instability intraoperatively. Severe bradycardia measuring 35 beats/min and hypotension measuring 78 mm Hg systolic were observed during surgery. Using stroke volume variation and stroke volume from the FloTrac as indices, successful circulatory management was performed with dopamine. The hypotension and bradycardia were thought to be the result of methyldigoxin and possibly associated with our perioperative management. Cardiology consult should have been obtained. We demonstrated that the FloTrac can be beneficial in diagnosing and managing cardiovascular instability and administration of dopamine in the anesthetic management of nonobstructive HCM patients.

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Copyright: © 2018 by the American Dental Society of Anesthesiology

Preoperative 12-lead electrocardiogram. Sinus bradycardia (heart rate 44 beats/min) and negative T wave (II, III, aVF, V3–6) were observed.


Contributor Notes

Address correspondence to Dr Aiji Sato(Boku), Department of Anesthesiology, Aichi Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusaku, Nagoya 464-8651, Japan; bokuaiji@dpc.aichi-gakuin.ac.jp.
Received: Nov 01, 2017
Accepted: Jan 09, 2018