Perioperative Tachyarrhythmias

Case Synopsis

A 68-year-old man develops sudden-onset fast atrial fibrillation during an emergency laparotomy under general anesthesia for an ischemic small bowel. The patient is hypotensive, with an irregular narrow complex tachycardia and a ventricular rate of 140 beats per minute. Cardiovascular stability is restored with an intravenous fluid bolus, vasopressors, electrolyte replacement, and an amiodarone infusion. Postoperatively the patient is transferred to the intensive care unit where he develops sudden-onset ventricular tachycardia necessitating immediate electrical cardioversion. The patient has further amiodarone loading and further electrolyte optimization.