Successful Management of Tachycardiac Atrial Fibrillation in a Septic Patient with Landiolol

To the Editor: In sepsis patients, management of tachycardia accompanied by hypotension is difficult. A 75-year-old man was admitted for urgent laparotomy because of septic peritonitis by superior mesenteric artery obstruction. General anesthesia was induced with propofol 60 mg, fentanyl 0.1 mg, and was maintained with supplementary fentanyl and sevoflurane. Although IV fluid administration and catecholamine infusion were continued from the admission, heart rate (HR) increased to 150 bpm, pulmonary artery pressure (PA) increased to 54 mm Hg, and systolic blood pressure (SBP) decreased to 90 mm Hg after the start of operation. Landiolol was started at the rate of 5 μg · kg−1 · min−1 for 15 min, and was maintained 2 to 3 μg · kg−1 · min−1. In 15 min after landiolol infusion, HR and PA decreased and stabilized at around 80 bpm, around 30 mm Hg, respectively (see Fig. 1 on page 295). SBP increased and stabilized at about 120 mm Hg. This case demonstrates that landiolol attenuated the tachycardia-induced low cardiac stroke volume and stabilized the hemodynamics in a patient with sepsis. Landiolol was reported to cause neither excessive hypotension nor cardiac decompression and is thought to be useful for treating tachycardia in sepsis patients (1,2). Yuko Yoshida, MD Takashi Hongo, MD Atsuhiro Sakamoto, MD Ryo Ogawa, MD Department of Anesthesiology Nippon Medical School Tokyo, Japan [email protected]