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Arrhythmias (fitness for anaesthesia)

Authoring team

Anaesthetic agents may sensitise the myocardium to the catecholamines released under stress: life-threatening arrhythmias such as ventricular fibrillation can be precipitated.

Some general guidelines at the preoperative anaesthetic assessment:

  • atrial fibrillation: try to get the apical rate less than 100bpm and the radial rate not more than 20bpm less
  • ventricular ectopics - any more than two of the following criteria may require the patient to be treated beforehand with an antiarrhythmic:
    • runs of three or more
    • ectopics occurring more than once in 4-5 beats
    • multifocal ectopics
    • 'R on T' phenomena
  • heart block:
    • 1st degree is acceptable
    • 2nd degree:
      • type I - no implication for general anaesthesia
      • type II - pace because risk of heart block
    • 3rd degree: pacing required

bundle branch block: caution is required if RBBB and left anterior descending branch is blocked - patient requires pacing

 

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