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KMID : 0356920140660010080
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Korean Journal of Anesthesiology
2014 Volume.66 No. 1 p.80 ~ p.84
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Torsade de pointes in liver transplantation recipient after induction of general anesthesia: a case report
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Chung Eun-Jin
Jeon Yun-Seok
Kim Hyun-Joo
Lee Kook-Hyun
Lee Ji-Won
Han Kyoung-Ah
Jung Seung-Hwan
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Abstract
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Torsade de pointes (TdP) is an uncommon and specific form of polymorphic ventricular tachycardia, associated with a prolonged QT interval. Prolongation of the QT interval is the most widely recognized electrophysiological abnormality in patients with liver cirrhosis. We observed a case of TdP leading to cardiopulmonary resuscitation after the induction of general anesthesia, in a patient with liver cirrhosis scheduled for emergency cadaveric donor liver transplantation. The patient had mild QT prolongation on preoperative electrocardiography with a corrected QT (QTc) interval of 455 ms. Drugs used in the preoperative period can elongate cardiac repolarization. Sevoflurane and 5-hydroxytryptamine type 3 receptor antagonists such as palonsetron, used during general anesthesia may have triggered further QT prolongation, producing a fatal condition such as TdP. More caution and consideration in selecting drugs for anesthetic management are necessary for liver cirrhosis patients, especially in patients with preoperative QT prolongation.
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KEYWORD
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Heart arrest, Liver transplantation, Long QT syndrome, Torsades de pointes
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