Anesthesia Lab II: Lecture 7 - Tachycardia/Bradycardia

Question 1

What is Tachycardia?

Answer 1

Defined as a HR ≥ 100 BPM

Question 2

What are common situations that can lead to Tachycardia?

Answer 2

• Intubation
• Surgical incision
• Emergence
• Severe hypovolemia
• Large EBL
• Pulmonary Embolus

Question 3

What is Bradycardia?

Answer 3

Defined as a HR < 60 BPM

Question 4

What are common surgical events that can lead to Bradycardia?

Answer 4

• Insufflation of abdomen during laparoscopic surgery
• Carotid manipulation during head and neck surgery

Question 5

What is a treatment for Bradycardia due to vagal reflexes?

Answer 5

Ask surgeons to stop the offending action

Question 6

What is the initial dose of glycopyrrolate for hemodynamically stable patients with persistent Bradycardia?

Answer 6

0.2 mg

Question 7

What is the dose of Atropine for hemodynamically unstable patients with Bradycardia?

Answer 7

0.4 mg

Question 8

What is the initial treatment for Bradycardia due to Neuraxial Anesthesia?

Answer 8

5-10 mg Ephedrine

Question 9

What is the treatment for severe Bradycardia?

Answer 9

• 10-20 mcg of Epinephrine
• Possible Epinephrine infusion
• 0.5 mg of Atropine repeated up to 3 mg total

Question 10

What is the treatment for Bradycardia caused by administered medications?

Answer 10

• Ephedrine if accompanied with hypotension
• Glycopyrrolate or Atropine if caused by Anticholinesterases

Question 11

What is the initial treatment for persistent Bradycardia that does not respond to pharmacologic treatment?

Answer 11

Transcutaneous pacing

Question 12

What should be prepared for persistent Bradycardia?

Answer 12

Transvenous pacing via central venous access

Question 13

What are the ‘H’s causes of Bradycardia?

Answer 13

• Hydrogen ion (acidemia)
• Hypoglycemia
• Hypokalemia
• Hyperkalemia
• Hypermagnesemia
• Hypothermia
• Hyperthermia (malignant hyperthermia)

Question 14

What are the ‘T’s causes of Bradycardia?

Answer 14

• Tamponade
• Tension pneumothorax

Question 15

What is the drug Esmolol used for?

Answer 15

Tachycardia treatment as a beta-1 specific antagonist

Question 16

What is the initial dose of Esmolol?

Answer 16

10 mg

Question 17

What is Metoprolol used for?

Answer 17

Treatment of persistent Tachycardia as a beta-1 specific antagonist

Question 18

What is the initial dose of Metoprolol?

Answer 18

1 mg

Question 19

What drugs can be used for Tachycardia associated with inadequate opioid levels?

Answer 19

• Fentanyl
• Dilaudid
• Morphine

Question 20

What is the treatment for Tachycardia associated with inadequate depth of Anesthesia?

Answer 20

• Propofol
• Volatile Agents

Question 21

What is defined as Sinus Tachycardia?

Answer 21

Sinus rhythm greater than 100 bpm

Question 22

What are common causes of Perioperative Sinus Tachycardia?

Answer 22

• Normal physiological response
• Anxiety or pain
• Sympathetic response to laryngoscopy and intubation
• Inadequate anesthesia during surgical incision
• Stimulation of airway reflexes during emergence and extubation

Question 23

What drugs can contribute to Perioperative Sinus Tachycardia?

Answer 23

• Anticholinergics (atropine, glycopyrrolate)
• β2-agonists (albuterol, terbutaline)
• Ketamine
• Desflurane
• Inotropic agents
• Pancuronium
• Stimulants (nicotine, caffeine)
• Illicit drugs (cocaine, amphetamine)

Question 24

What is the reference for further information on Perioperative Sinus Tachycardia?

Answer 24

https://www.openanesthesia.org/keywords/perioperative-sinus-tachycardia/

Question 25

What is another reference for Perioperative Sinus Tachycardia?

Answer 25

https://www.uptodate.com/contents/image?imageKey=ANEST%2F127098&topicKey=ANEST%2F94357&source=see_link