Korean J Anesthesiol.  1994 Oct;27(10):1470-1473. 10.4097/kjae.1994.27.10.1470.

A Case Report of Severe Bradycardia and Mobitz Type I A-V Block after Anesthetic Induction with a Fentanyl-Propofol Sequence

• Cho YJ
• Song SY
• Lim GJ

• KMID: 2240525
• DOI: http://doi.org/10.4097/kjae.1994.27.10.1470

Abstract

Severe bradycardia has been associated with a number of medications used for induction of anesthesia. Fentanyl and other potent opioids are well known for their central vagotonic effect, particularly when given rapidly in high doses. Propofol administration has also been associated with bradycardia, and may even exert a central vagotonic or sympatholytic ef- fect, or both. The anesthetic induction with propofol fentanyl may be followed by severe bradycardia in patients who have not received atropine. The bradyeardia may be prevented by premedication with atropine. We report a case in which anesthesia was induced with fentanyl 3 ug/kg and propofol 2. 5mg/kg in 43 year old female patient undergoing oophorectomy. Twenty or thirty seconds after injection of propofol and fentanyl the reduction of blood pressure and severe bradycardia appeared along with premature ventricular contraction and Mobitz type I A-V block. Immediate therapy was initiated with injection of atropine 0.5mg and hyperventilation with 100% oxygen. After about one minute the vital sign of the patient returned to normal. We emphasize that anticholinergic and oxygen before induction with fentanyl propofol should be administered to prevent possible bradycardia and hypoxia.

Keyword

Fentanyl; Propofol; Bradycardia; Mobitz type I A-V block

MeSH Terms

Adult
Analgesics, Opioid
Anesthesia
Anoxia
Atropine
Blood Pressure
Bradycardia*
Female
Fentanyl
Humans
Hyperventilation
Ovariectomy
Oxygen
Premedication
Propofol
Ventricular Premature Complexes
Vital Signs
Analgesics, Opioid
Atropine
Fentanyl
Oxygen
Propofol