Mesh : Adjuvants, Anesthesia / adverse effects Adult Anesthesia, Inhalation / methods nursing Anesthesia, Intravenous / methods nursing Anesthetics, Inhalation / adverse effects Atropine / therapeutic use Cholinesterase Inhibitors / adverse effects Desflurane Dexmedetomidine / adverse effects Droperidol / adverse effects Drug Monitoring / nursing Electrocardiography Female Gastric Bypass Heart Block / chemically induced diagnosis drug therapy Humans Hypnotics and Sedatives / adverse effects Indoles / adverse effects Isoflurane / adverse effects analogs & derivatives Long QT Syndrome / chemically induced diagnosis etiology Muscarinic Antagonists / therapeutic use Neostigmine / adverse effects Nurse Anesthetists Obesity, Morbid / complications surgery Quinolizines / adverse effects Risk Factors Serotonin Antagonists / adverse effects

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Abstract:
Heart block and Q-Tc interval prolongation have been reported with several agents used in anesthesia, and the US Food and Drug Administration mandates evaluation of the Q-T interval with new drugs. Drug-induced Q-T interval prolongation may precipitate life-threatening arrhythmias, is considered a precursor for torsades de pointes, and may predict cardiovascular complications. In the patient described in this article, heart block occurred and the Q-Tc interval became prolonged after muscle relaxant reversal with neostigmine; both were considered to be related to the combination of agents used in the case, as well as to other predisposing factors such as morbid obesity. The agents used that affected cardiac conduction were neostigmine, desflurane, droperidol, dolasetron, and dexmedetomidine. Although the heart block was resolved after 2 doses of atropine, prolonged P-R and Q-Tc intervals persisted into the immediate postoperative period but returned to baseline within 4 hours. Clinical implications of this report include increasing awareness of the multitude of factors affecting Q-T interval prolongation during anesthesia.
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