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Main Article Content
Asymptomatic presentation of atrial fibrillation in a patient scheduled for emergency exploratory laparotomy
Abstract
The diagnosis of Atrial Fibrillation (AF) constitutes a significant consideration to the Anaesthetist. We report a-56-years old man with asymptomatic AF, undergoing emergency laparotomy on account of bowel obstruction from colonic mass. An incidental suspicion of AF was made with radial artery palpation and subsequently confirmed with an urgent 12-lead electrocardiogram (ECG). He had a multidisciplinary review, and was placed on metoprolol 25mg. He had the surgery under general anaesthesia. About five minutes into the procedure, there were signs of supraventricular tachyarrhythmia (SVT), possibly AF with cardiovascular (CVS) perturbations, i.e., pulse rate (PR) of 190bpm and blood pressure (BP) of 64/38mmHg. Rate control was achieved with intravenous labetalol 5mg every 60 seconds in aliquot, till total of 55mg, and RR < 120bpm, BP - 110/60mmHg and sinus rhythm restoration. The AF triggers, i.e., light anaesthesia, pain, vagal stimuli, and volume imbalance were corrected. Subsequent intra- and postoperative care were uneventful. He was placed on daily tab metoprolol 25mg, and aspirin 75mg, discharged home and seen in clinic.
French title: Présentation asymptomatique de fibrillation auriculaire chez un patient prévu pour une laparotomie exploratoire d'urgence
Le diagnostic de fibrillation auriculaire (FA) constitue une considération importante pour l'anesthésiste. Nous rapportons le cas d'un homme de 56 ans atteint de FAasymptomatique, soumis à une laparotomie d'urgence en raison d'une occlusion intestinale due à une masse colique. Une suspicion fortuite de FAa été faite par palpation de l'artère radiale et ultérieurement confirmée par un électrocardiogramme (ECG) à 12 dérivations en urgence. Il a eu un examen multidisciplinaire et a été placé sous métoprolol 25 mg. Il a été opéré sous anesthésie générale. Environ cinq minutes après le début de l'intervention, il y avait des signes de tachyarythmie supraventriculaire (TSV), peut-être une FA avec perturbations cardiovasculaires (CVS), c'est-à-dire une Fréquence Cardiaque (FP) de 190 bpm et une pression artérielle (PA) de 64/38 mmHg. Le contrôle de la fréquence a été obtenu par administration intraveineuse de labétalol 5 mg toutes les 60 secondes en aliquote, jusqu'à un total de 55 mg, et une RR < 120 bpm, une PA - 110/60 mmHg et une restauration du rythme sinusal. Les déclencheurs de FA, c'est-à-dire une anesthésie légère, la douleur, les stimuli vagaux et le déséquilibre volumique ont été corrigés. Les soins peropératoires et postopératoires ultérieurs se sont déroulés sans incident. Il a été placé sous métoprolol 25 mg par jour et aspirine 75 mg, a été renvoyé chez lui et a été vu en clinique.
