Key result
Toxic serum levels of sotalol (7.1 mg/L) due to renal graft failure precipitated ventricular tachycardia and fibrillation during induction of anaesthesia for a transplant nephrectomy.
Case Report (n=1)
This case highlights the risk of life-threatening arrhythmias due to sotalol toxicity if doses are not adjusted following renal function decline.
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Sotalol accumulation may trigger perioperative arrhythmias in renal impairment; leaves open need for adjusted protocols and monitoring studies.
A 44 year-old woman was anaesthetised for a transplant nephrectomy. About 10 min after induction of anaesthesia she had several runs of ventricular tachycardia followed by ventricular fibrillation requiring 30 s of cardiopulmonary resuscitation, after which she reverted to sinus rhythm. Review of her chest X-ray, suggested that the haemodialysis catheter (Permcath) position may have precipitated this event. However, subsequent investigation found that she had toxic serum levels of sotalol, with a prolonged corrected QT interval on the electrocardiogram. She was started on sotalol while her renal graft was functioning well but it was not reviewed when the graft started to fail and she had to commence haemodialysis. This led to the accumulation of sotalol and explains her serum sotalol value of 7.1 mg x l(-1) on the day of the event. Concentrations greater than 2.5 mg x l(-1) are generally considered toxic.
Srivastava et al. (2009) conducted a case report in Sotalol toxicity and ventricular arrhythmias during anaesthesia (n=1). Sotalol toxicity was evaluated on Ventricular tachycardia followed by ventricular fibrillation. Toxic serum levels of sotalol (7.1 mg/L) due to renal graft failure precipitated ventricular tachycardia and fibrillation during induction of anaesthesia for a transplant nephrectomy.