Perioperative Management of Patients with Bradyarrhythmias Undergoing Noncardiac Surgery

The relevance of the problem of prophylaxis and treatment of perioperative arrhythmias is due to the fact that a widening range of surgical interventions is performed, including elderly patients, burdened with concomitant cardiac pathology. The article reviews Russian and foreign clinical guidelines and handbooks for managing patients with bradyarrhythmias in non-cardiac surgery. Key information about the physiology of electrical impulse in the myocardium, the formation of a normal ECG, as well as the main signs of cardiac rhythm pathology is given; “safe” and potentially dangerous bradyarrhythmias are indicated. The mechanism of development of intraoperative reflex bradycardia, which is a specific complication of some ophthalmic, maxillofacial and laparoscopic operations, is considered. The review presents managing patients with certain types of bradyarrhythmias in the perioperative period: sinus bradycardia, sinus node weakness syndrome, conduction disorders. Separately the questions of implantable antiarrhythmic devices, anesthesia during arrhythmic operations are described. The analysis of recommendations on the choice of the method of anesthesia, monitoring, used drugs in patients with concomitant cardiac arrhythmias, the algorithm of emergency therapy in the perioperative period for potentially dangerous forms of bradyarrhythmia was conducted.