Abstract
Despite the recent advance of anesthetic management such as remifentanil, unpredictable arrhythmias remain critical problem during perioperative periods. American College of Cardiology/American Heart Association guidelines for the management of tachycardia certainly helps us even in anesthesia. First, if the patient presents tachyarrhythmia, we should evaluate whether the patient is stable or unstable. Then, if the patient is unstable due to the tachycardia, immediate cardioversion is indicated. If the patient is stable, we should evaluate the ECG, then determine whether the QRS complex is narrow or wide and regular or irregular. A regular, narrow QRS complex tachycardia is presumed to be supraventricular tachycardia and should be treated with ATP. After sinus rhythm conversion, beta-blocker is indicated for preventing recurrence. An irregular narrow QRS complex tachycardia is presumed to be atrial fibrillation and should be treated with beta-blocker in order to control the heart rate. Landiolol hydrochloride, an ultra-short acting beta-blocker, has advantages in this situation. Patients treated with beta-blocker often make an excellent recovery from atrial fibrillation. If the blood pressure deteriorates, landiolol hydrochloride should be discontinued. Landiolol hydrochloride is also effective to treat ventricular tachyarrhythmia with Nifekalant hydrochloride during weaning of the cardiopulmonary bypass in cardiac surgery. In conclusion, anesthesiologists should use beta-blockers appropriately to treat tachyarrhythmia during perioperative periods.
