Burjorjee Jessica E, Milne Brian
Department of Anaesthesiology, Queen's University, Kingston, Ontario, Canada.
Can J Anaesth. 2002 Nov;49(9):973-7. doi: 10.1007/BF03016886.
To present a case report where propofol abolished recurrent ventricular tachycardia (VT) and to suggest a mechanism by which this may have occurred.
A 65-yr-old male was admitted to the intensive care unit (ICU) with electrical storm. Recurrent episodes of VT persisted despite maximal anti-arrhythmic therapy and resulted in a prolonged ICU course and the need for intra-aortic balloon pump support. This was complicated by an ischemic limb, necessitating an anesthetic for femoral thrombectomy. On several occasions while in the ICU, episodes of VT had resolved with boluses of propofol prior to planned cardioversion. In the operating room, episodes of non-sustained VT resolved after a bolus of propofol and remained suppressed for the duration of the case with the use of a propofol infusion.
The effects of propofol on cardiac conduction and on the autonomic nervous system have been studied but its effects on arrhythmias are not well documented. In this case report, propofol was associated with the resolution and suppression of VT. Recent evidence suggests that sympathetic blockade may be an effective treatment for electrical storm. This may be the mechanism by which propofol can abolish this arrhythmia intraoperatively.
报告一例丙泊酚消除复发性室性心动过速（VT）的病例，并提出其可能的发生机制。
一名65岁男性因电风暴入住重症监护病房（ICU）。尽管进行了最大程度的抗心律失常治疗，VT仍反复发作，导致ICU住院时间延长，并需要主动脉内球囊泵支持。该患者合并肢体缺血，需要进行股动脉血栓切除术麻醉。在ICU期间，有几次在计划心脏复律前，静脉注射丙泊酚后VT发作缓解。在手术室，静脉注射丙泊酚后非持续性VT发作缓解，并在手术过程中持续使用丙泊酚输注维持抑制状态。
丙泊酚对心脏传导和自主神经系统的作用已得到研究，但其对心律失常的影响尚无充分文献记载。在本病例报告中，丙泊酚与VT的缓解和抑制有关。最近的证据表明，交感神经阻滞可能是治疗电风暴的有效方法。这可能是丙泊酚在术中能够消除这种心律失常的机制。
