Conversion of supraventricular arrhythmia to normal rhythm by propofol and remifentanil: three cases report
A 79-year-old male (weight 50 kg) was scheduled for clipping of aneurysm of subarachnoid hemorrhage. The patient was stuporous and had a tracheostomy. ECG taken immediately before surgery revealed atrial fibrillation and T wave inversion. The precise medical history was unobtainable; the patient's family was unaware of atrial fibrillation. A chest X-ray was consistent with emphysema. Preoperative laboratory results were unremarkable except for low serum potassium (3.2 mEq/L). No premedication was given before surgery. On arrival at the operating room, blood pressure, heart rate, oxygen saturation were 130/70 mmHg, 99 beats/min, and 92%, respectively. Anesthesia was induced with TCI of propofol (2.5 µg/ml) and remifentanil (0.1 µg/kg/min). Rocuronium 50 mg was administered intravenously, and endotracheal intubation was performed. Anesthesia was maintained with TCI of propofol and remifentanil in an oxygen-air mixture (FiO2 = 0.5). About 10 minutes after tracheal intubation, the rhythm changed to NSR, which reverted to atrial fibrillation on postoperative day 2 and persisted.