This case highlights the rare occurrence of atrial fibrillation and paroxysmal supraventricular tachycardia during general anesthesia induction and emergence in a healthy young male, potentially triggered by autonomic imbalance from glycopyrrolate and underlying alcohol use.
May warrant vigilance for glycopyrrolate-related arrhythmias under anesthesia; single case leaves open causality and generalizability.
A healthy 35-year-old man who was scheduled for closed reduction of nasal bone fracture developed atrial fibrillation during induction of general anesthesia after intravenous glycopyrrolate injection. During emergence of general anesthesia, atrial fibrillation was suddenly changed to paroxysmal supraventricular tachycardia with 200 beat per minute and lasted for about 10 seconds. Because blood pressure was stable, esmolol was used to reduce ventricular response. At recovery room, ventricular response reduction about 55 beat per minute was observed after intravenous injection of verapamil 5 mg. Thereafter, the rhythm was returned to normal sinus rhythm with bradycardia. (Ewha Med J 2012;35(2):119-123)
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Bang et al. (2012) studied this question.
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