Abstract
We had a patient receiving several kinds of anticonvulsants who developed Wenckebach-type atrioventricular (AV) block after traumatic amputation of the left toes. Wenckebach-type AV block was changed to first-degree AV block before the operation. The autonomic nervous system imbalance caused by severe pain after the trauma was thought to have induced the AV block. In addition, the anticonvulsants, carbamazepine and fenytoin, might have contributed to the onset of the AV block, because both have the property of AV node suppression. Anesthesia was uneventfully performed by general anesthesia with inhaled sevoflurane and intravenous fentanyl. The AV block induced by autonomic nervous system imbalance can be easily treated with atropine, and is therefore considered to be comparatively benign. In the patient receiving anticonvulsants, the preoperative evaluation should be carefully carried out taking into account that there is a possibility of inducing AV block, and it may be induced by external causes, such as trauma, like in our patient.
