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KMID : 0356919940270101470
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Korean Journal of Anesthesiology
1994 Volume.27 No. 10 p.1470 ~ p.1473
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A Case Report of Severe Bradycardia and Mobitz Type I !-V Block after Anesthetic Induction with a Fentanyl-Propofol Sequence
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Abstract
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Severe bradycardia has been associated with a number of medications used for induction of anesthesia. Fentanyl and other potent opioids are well known for their central vagotonic effect, particularly when given rapidly in high doses. Propofol
administration has also been associated with bradycardia, and may even exert a central vagotonic or sympatholytic effect, or both. The anesthetic induction with propofol-fentanyl may be followed by severe bradycardia in patients who have not
received
atropine. The bradycardia may be prevented by premedication with atropine.
We report a case in which anesthesia was induced with fentanyl 3㎍/kg and propofol 2.5mg/kg in 43-year old female patient undergoing oophorectomy. Twenty or thirty seconds after injection of propofol and fentanyl the reduction of blood pressure
and
severe bradycardia appeared along with premature ventricular contraction and Mobitz type I A-V block. Immediate therapy was initiated with injection of atropine 0.5mg and hyperventilation with 100% oxygen. After about one minute the vital sign of
the
patient returned to normal.
We emphasize that anticholinergic and oxygen before induction with fentanyl-propofol should be administered to prevent possible bradycardia and hypoxia.
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KEYWORD
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