Nodal Tachycardia Induced By Neostigmine Administration During Off-Pump Coronary Artery Bypass Graft Surgery: What Makes the Difference? A Case Report.

Controlling the heart rate (HR) to a proper level is an important part during off-pump coronary artery bypass graft (CABG) surgery, particularly in two aspects. First, the oxygen consumption during cardiac work could be decreased, which is obviously beneficial for the myocardium suffering from inadequate blood supply. Second, slow heart action makes it easy for surgeons to perform. There are some treatments for lowering HR, where neostigmine is not commonly used but usually effective, which had been discussed more than 50 years ago. However, there are adverse responses that cannot be ignored and are even dangerous, for example, severe bradyarrhythmia and overload of secretion in the trachea. Here, we report a nodal tachycardia case after neostigmine infusion.