Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
J Cardiothorac Vasc Anesth. 2022 Apr;36(4):952-961. doi: 10.1053/j.jvca.2021.05.008. Epub 2021 May 11.
The recently released American Heart Association (AHA) scientific statement on drug-induced arrhythmias discussed medications commonly associated with bradycardia, supraventricular tachycardias, and ventricular arrhythmias. The foundational data for this statement were collected from general outpatient and inpatient populations. Patients undergoing surgical and minimally invasive treatments are a unique subgroup, because they may experience hemodynamic changes associated with anesthesia and their procedure, receive multiple drug combinations not given in either inpatient or outpatient settings, or experience postprocedural inflammatory syndromes. Accordingly, the generalizability of the AHA scientific statement to this perioperative population is unclear. This focused review highlights important aspects of the new AHA scientific statement and their application to the perioperative setting. The authors review medications frequently encountered and given by anesthesiologists and their risk of drug-induced arrhythmias and discuss common anesthetic and adjunctive medications and their associated risks of bradycardia, atrial fibrillation, torsades de pointes, and drug-induced Brugada syndrome. In many instances, the risk of arrhythmia reported by the AHA scientific statement in the general population appeared to be higher than found in perioperative arenas. Furthermore, the authors discuss the arrhythmia risk of additional medications commonly ordered or administered by anesthesiologists that are not included in the AHA scientific statement. As patient and procedural complexity increases and novel anesthetic combinations propagate, further research and observational studies will be required to delineate further perioperative risks for drug-induced arrhythmia.
最近发布的美国心脏协会（AHA）关于药物诱导心律失常的科学声明讨论了与心动过缓、室上性心动过速和室性心律失常常见相关的药物。该声明的基础数据来自一般门诊和住院人群。接受手术和微创手术治疗的患者是一个独特的亚组，因为他们可能会经历与麻醉和手术相关的血流动力学变化，接受多种不在住院或门诊环境中使用的药物组合，或经历术后炎症综合征。因此，AHA 科学声明对该围手术期人群的普遍性尚不清楚。本重点综述强调了新的 AHA 科学声明的重要方面及其在围手术期环境中的应用。作者回顾了麻醉师经常遇到和使用的药物及其引起心律失常的风险，并讨论了常见的麻醉和辅助药物及其与心动过缓、心房颤动、尖端扭转型室性心动过速和药物诱导 Brugada 综合征相关的风险。在许多情况下，AHA 科学声明在普通人群中报告的心律失常风险似乎高于围手术期。此外，作者还讨论了麻醉师经常开处方或使用但不在 AHA 科学声明中的其他药物的心律失常风险。随着患者和手术复杂性的增加以及新型麻醉组合的传播，需要进一步的研究和观察性研究来阐明围手术期药物诱导心律失常的进一步风险。
