Perrault L P, Denault A Y, Carrier M, Cartier R, Bélisle S
Department of Surgery, Montreal Heart Institute, Quebec, Canada.
Can J Anaesth. 2000 Mar;47(3):251-4. doi: 10.1007/BF03018922.
Postoperative delirium occurs in about 2% of patients undergoing major cardiac surgery including coronary artery bypass grafting surgery (CABG). Haloperidol (Sabex, Boucherville, Canada) is a drug commonly used in the intensive care unit for the treatment of delirium and is usually considered safe even at high doses and is rarely implicated in the development of malignant ventricular arrhythmias such as torsades de pointes. The purpose of this study is to report such a complication of use of haloperidol after myocardial revascularization.
The patient reported underwent uneventful triple bypass surgery. Administration of large intravenous doses of haloperidol was necessary for control of psychomotor agitation due to delirium. Torsades de pointes occurred in the absence of QT prolongation on the third postoperative day following use of the drug with no other obvious etiological factor.
Awareness of this rare complication is key to judicious use of this drug in the post CABG patient in whom such an arrhythmia may have very deleterious consequences because of the underlying cardiac condition.
术后谵妄发生在约2%接受包括冠状动脉旁路移植术（CABG）在内的重大心脏手术的患者中。氟哌啶醇（Sabex，加拿大布舍维尔）是重症监护病房常用的治疗谵妄的药物，即使大剂量使用通常也被认为是安全的，很少与恶性室性心律失常如尖端扭转型室速的发生有关。本研究的目的是报告心肌血运重建术后使用氟哌啶醇的这种并发症。
报告的患者接受了顺利的三支血管搭桥手术。由于谵妄导致精神运动性激越，需要静脉注射大剂量氟哌啶醇进行控制。在使用该药物后的术后第三天，在无QT间期延长且无其他明显病因的情况下发生了尖端扭转型室速。
认识到这种罕见并发症是在冠状动脉旁路移植术后患者中明智使用该药物的关键，因为潜在的心脏疾病，这种心律失常可能会产生非常有害的后果。
