Altered responses to vasopressors of a patient medicated with carvedilol, pilsicainide and enalapril

Journal of Anesthesia
Kumi Nakamura, Norihiko Fukami

Abstract

A patient scheduled for laparoscopic rectal surgery was medicated with carvedilol, an antagonist of beta 1-, beta 2- and alpha 1-adrenergic receptors, pilsicainide, a class Ic antiarrhythmic drug and enalapril, an angiotensin-converting enzyme inhibitor. Because the patient experienced attacks of atrial fibrillation with rapid ventricular response almost weekly, carvedilol and pilsicainide were continued up to the day of surgery, while enalapril was discontinued for 24 h prior to surgery. During the operation, he showed prolonged hypotension that did not respond to usual doses of vasopressors such as ephedrine, phenylephrine and dopamine but responded to higher doses of norepinephrine. Postoperatively, he was given dopamine but exhibited tachyarrhythmia until the dopamine infusion was discontinued.

References

Feb 13, 2003·British Journal of Clinical Pharmacology·Rahmatina B HermanChim C Lang
Jun 21, 2005·Journal of Cardiovascular Pharmacology and Therapeutics·Lei HuangXiangshao Fang
Dec 8, 2010·Cardiology in Review·Alexander Wolf, Kathryn E McGoldrick

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