Intraoperative awareness as an example of the influence of cardiac output on anesthetic dosing: case report
Keywords:
Catheter Ablation, Isoproterenol, Adverse effects, Propofol, Intraoperative Awareness
Abstract
A case of intraoperative awareness during ablation of pulmonary veins-one of the most widely used techniques in interventional cardiology-is discussed. An infusion of isoproterenol was administered following the ablation of ectopic foci. A few seconds after the infusion the patient experienced increased heart rate and intraoperative awareness manifested as an abrupt patient movement and bispectral index elevation. This has been described in similar procedures, following the administration of isoproterenol. In our opinion, the isoproterenol infusion caused the increased heart rate and subsequent abrupt rise in cardiac output. As an inversely proportional relationship between the propofol concentrations and cardiac output has been described, we believe that this rise in cardiac output could have favored the decline in the concentrations of propofol, leading to an intraoperative awareness episode.
References
1. Di Biase L, Conti S, Mohanty P, et al. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm 2011;8:368-372.
2. Fattorini F, Romano R, Ciccaglioni A, et al. Effects of remifentanil on human heart electrical system. A transesophageal pacing electrophysiological study. Minerva Anestesiol 2003;69:673-7-677-9.
3. Warpechowski P, Lima GG, Medeiros CM, et al. Randomized study of propofol effect on electrophysiological properties of the atrioventricular node in patients with nodal reentrant tachycardia. Pacing Clin Electrophysiol 2006;29:1375-1382.
4. Castellon-Larios K, Rosero B, Niño-de Mejía M, et al. The use of cerebral monitoring for intraoperative awareness. Rev Colomb Anestesiol 2016;44:23-29.
5. Upton RN, Ludbrook GL, Grant C, et al. Cardiac output is a determinant of the initial concentrations of propofol after short-infusion administration. Anesth Analg 1999;89:545-552.
6. Myburgh JA, Upton RN, Grant C, et al. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med 2001;27:276-282.
7. Ghoneim MM. Awareness during anesthesia. Anesthesiology 2000;92:597-602.
8. O’Neill DK, Aizer A, Linton P, et al. Isoproterenol infusion increases level of consciousness during catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2012;34:137-142.
9. Matthews R. Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report. AANA J 2006;74:193-195.
10. Johnson IA, Andrzejowski J, Sikiotis L. Arousal following isoprenaline. Anaesth Intensive Care 1999;27:221.
11. Kurita T, Morita K, Kazama T, et al. Influence of cardiac output on plasma propofol concentrations during constant infusion in swine. Anesthesiology 2002;96:1498-1503.
12. Takizawa D, Nishikawa K, Sato E, et al. A dopamine infusion decreases propofol concentration during epidural blockade under general anesthesia. Can J Anaesth 2005;52:463-466.
13. Takizawa E, Takizawa D, Al-Jahdari WS, et al. Influence of atropine on the dose requirements of propofol in humans. Drug Metab Pharmacokinet 2006;21:384-388.
14. Shin HW, Ban YJ, Lee HW, et al. Arousal with IV epinephrine depends on the depth of anesthesia. Can J Anaesth 2004;51: 880-885.
15. Andrzejowski J, Sleigh JW, Johnson IA, et al. The effect of intravenous epinephrine on the bispectral index and sedation. Anaesthesia 2000;55:761-763.
16. Ishiyama T, Oguchi T, Iijima T, et al. Ephedrine, but not phenylephrine, increases bispectral index values during combined general and epidural anesthesia. Anesth Analg 2003;97:780-784.
17. Ghosh I, Bithal PK, Dash HH, et al. Both clonidine and metoprolol modify anesthetic depth indicators and reduce intraoperative propofol requirement. J Anesth 2008;22:131-134.
2. Fattorini F, Romano R, Ciccaglioni A, et al. Effects of remifentanil on human heart electrical system. A transesophageal pacing electrophysiological study. Minerva Anestesiol 2003;69:673-7-677-9.
3. Warpechowski P, Lima GG, Medeiros CM, et al. Randomized study of propofol effect on electrophysiological properties of the atrioventricular node in patients with nodal reentrant tachycardia. Pacing Clin Electrophysiol 2006;29:1375-1382.
4. Castellon-Larios K, Rosero B, Niño-de Mejía M, et al. The use of cerebral monitoring for intraoperative awareness. Rev Colomb Anestesiol 2016;44:23-29.
5. Upton RN, Ludbrook GL, Grant C, et al. Cardiac output is a determinant of the initial concentrations of propofol after short-infusion administration. Anesth Analg 1999;89:545-552.
6. Myburgh JA, Upton RN, Grant C, et al. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med 2001;27:276-282.
7. Ghoneim MM. Awareness during anesthesia. Anesthesiology 2000;92:597-602.
8. O’Neill DK, Aizer A, Linton P, et al. Isoproterenol infusion increases level of consciousness during catheter ablation of atrial fibrillation. J Interv Card Electrophysiol 2012;34:137-142.
9. Matthews R. Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report. AANA J 2006;74:193-195.
10. Johnson IA, Andrzejowski J, Sikiotis L. Arousal following isoprenaline. Anaesth Intensive Care 1999;27:221.
11. Kurita T, Morita K, Kazama T, et al. Influence of cardiac output on plasma propofol concentrations during constant infusion in swine. Anesthesiology 2002;96:1498-1503.
12. Takizawa D, Nishikawa K, Sato E, et al. A dopamine infusion decreases propofol concentration during epidural blockade under general anesthesia. Can J Anaesth 2005;52:463-466.
13. Takizawa E, Takizawa D, Al-Jahdari WS, et al. Influence of atropine on the dose requirements of propofol in humans. Drug Metab Pharmacokinet 2006;21:384-388.
14. Shin HW, Ban YJ, Lee HW, et al. Arousal with IV epinephrine depends on the depth of anesthesia. Can J Anaesth 2004;51: 880-885.
15. Andrzejowski J, Sleigh JW, Johnson IA, et al. The effect of intravenous epinephrine on the bispectral index and sedation. Anaesthesia 2000;55:761-763.
16. Ishiyama T, Oguchi T, Iijima T, et al. Ephedrine, but not phenylephrine, increases bispectral index values during combined general and epidural anesthesia. Anesth Analg 2003;97:780-784.
17. Ghosh I, Bithal PK, Dash HH, et al. Both clonidine and metoprolol modify anesthetic depth indicators and reduce intraoperative propofol requirement. J Anesth 2008;22:131-134.
How to Cite
1.
Catalá-Ripoll JV, Hidalgo-Olivares VM, Monsalve-Naharro J Ángel, Gerónimo-Pardo M. Intraoperative awareness as an example of the influence of cardiac output on anesthetic dosing: case report. Colomb. J. Anesthesiol. [Internet]. 2018 Oct. 1 [cited 2024 May 8];46(4):341-4. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/419
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Published
2018-10-01
How to Cite
1.
Catalá-Ripoll JV, Hidalgo-Olivares VM, Monsalve-Naharro J Ángel, Gerónimo-Pardo M. Intraoperative awareness as an example of the influence of cardiac output on anesthetic dosing: case report. Colomb. J. Anesthesiol. [Internet]. 2018 Oct. 1 [cited 2024 May 8];46(4):341-4. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/419
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Section
Case Report / Case Series
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