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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Ura, Akihiro Fujii, Keisuke Tanioku, Tadashi Kawamata, Tomoyuki |
| Abstract | Background Remifentanil, an ultra-short-acting ยต-opioid receptor agonist, is commonly used for anesthetic management due to excellent adjustability. Remifentanil is known to cause sinus bradycardia, however, because it has a direct negative chronotropic effect on the cardiac conduction system and there is an indirect negative chronotropic effect via the parasympathetic nervous system. Case presentation An 8-year-old Japanese boy was diagnosed with acute hydrocephalus due to a brain tumor in the fourth ventricle and underwent emergency surgery. Imaging examination showed brainstem compression. Endoscopic third ventriculostomy and ventriculoperitoneal shunt surgery were scheduled. Remifentanil was started during induction of general anesthesia, but electrocardiogram showed sinus bradycardia, then Wenckebach-type atrioventricular block, and then complete atrioventricular block. Remifentanil was immediately discontinued, and we administered atropine sulfate. Complete atrioventricular block was restored to sinus rhythm. When remifentanil was restarted, however, the electrocardiogram again showed sinus bradycardia, Wenckebach-type atrioventricular block, and then complete atrioventricular block. Remifentanil was again immediately discontinued, we administered adrenaline, and then complete atrioventricular block was restored to sinus rhythm. Fentanyl was used instead of remifentanil with continuous infusion of dopamine. There has since been no further occurrence of complete atrioventricular block. Conclusions This is the first known case of complete atrioventricular block in a pediatric patient with increased intracranial pressure seemingly caused by administration of remifentanil. |
| Related Links | https://bmcanesthesiol.biomedcentral.com/counter/pdf/10.1186/s12871-024-02593-8.pdf |
| Ending Page | 5 |
| Page Count | 5 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 14712253 |
| DOI | 10.1186/s12871-024-02593-8 |
| Journal | BMC Anesthesiology |
| Issue Number | 1 |
| Volume Number | 24 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2024-08-09 |
| Access Restriction | Open |
| Subject Keyword | Anesthesiology Internal Medicine Emergency Medicine Intensive Critical Care Medicine Remifentanil Complete atrioventricular block Brainstem compression Pediatric neurosurgery |
| Content Type | Text |
| Resource Type | Case study |
| Subject | Anesthesiology and Pain Medicine |
| Journal Impact Factor | 2.3/2023 |
| 5-Year Journal Impact Factor | 2.6/2023 |
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