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A case of severe bradycardia and AV block during administration of propofol

机译：在丙酚给药过程中严重的心动过缓和AV嵌段的情况

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A 69-yr-old man underwent emergency laparotomy. He was in endotoxic shock. Preoperative evaluation including a full blood count, chest X-ray and ECG were normal. Body temperature was 37.4 degrees C. Preoperative arterial pressure was 140/80 mmHg and heart rate 65 bpm. Anesthesia was induced with ketamine 100 mg, propofol 20 mg, fentanyl 50 micrograms and vecuronium 4 mg and maintained with propofol 4 mg.kg-1.hr-1 and fentanyl. Soon after opening the abdominal peritoneum, severe bradycardia (< 20 bpm) occurred, but it was effectively treated by ephedrine 16 mg. After that, surgery was performed uneventfully. In the intensive care unit (ICU), the patient developed four episodes of severe atrioventricular (AV) block after stimulation of the trachea by suction drainage under sedation with propofol, although there was no AV block during sedation with ketamine and propofol. After stopping propofol, the AV block was no longer observed. He was discharged from the ICU on the 12th postoperative day. Postoperative Holter ECG and echocardiography showed no abnormalities. It is likely that stimulation of the trachea triggered vagovagal reflex and propofol prolonged AV conduction, causing the AV block.
机译：一个69岁的老人接受了紧急剖腹手术。他处于内毒性休克。术前评估，包括全血计数，胸X射线和心电图是正常的。体温为37.4摄氏度。术前动脉压力为140/80mmHg和心率65bpm。用氯胺酮100mg，丙豆醇20mg，芬太尼诱导麻醉，50微克和veCuronium 4mg，并用异丙酚4mg.kg-1.hR-1和芬太尼保持。打开腹部腹膜后，发生严重的心动过缓（<20bpm），但通过麻黄碱16毫克有效处理。之后，手术是不确定的。在重症监护单元（ICU）中，患者在用异丙酚下的吸入引流刺激气管后，患者在刺激气管后开展了四次严重的房室（AV）嵌段，尽管在镇静剂中没有氯胺酮和异丙酚在镇静期间没有AV嵌段。在停止异丙酚后，不再观察到AV块。他在术后第12天从ICU出院。术后Holter ECG和超声心动图显示出没有异常。气管的刺激可能触发迷山反射和异丙酚延长的AV传导，导致AV块。

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