Anesthetic management of intraoperative atrioventricular tachyarrhythmia in a postpartum patient posted for laparotomy

Abstract

Supraventricular tachycardia is the most common sustained arrhythmia presenting in pregnancy. The increase in frequency of arrhythmias and in symptoms during pregnancy may be a result of associated hemodynamic, hormonal, autonomic, and emotional changes. A 21-year-old, post-partum patient on the 5th postoperative day was posted for laparotomy in view of pelvic abscess. Surgery was started, and after opening the abdomen, 1–1.5 L pus was drained and a lot of adhesions were noted in pelvic region. Intestinal adhesiolysis and thorough peritoneal wash were performed. In intraoperative period, suddenly, patient's heart rate was increased to 233 bpm and blood pressure dropped to 80/60 mmHg. Resuscitated with fluids, blood and drugs like phenylephrine to imporve blood pressure. Inspite of these resuscitative efforts heart rate was fixed at 233/min with blood presure improved to 110/80mmhg. A cardiologist opinion was taken and they diagnosed it as atrioventricular reentrant tachycardia and advised injection adenosine 6 mg intravenous (IV). After adenosine IV bolus, heart rate dropped transiently up to 60 bpm and later stabilized at preoperative basal heart rate of 132 bpm with blood pressure of 128/80 mmHg. The most important aspect in treating tachyarrhythmia patients is the use of a multidisciplinary approach. The decision of what therapy to use must be addressed on a case-by-case basis with special attention to the patient's individual issues and concerns.