Management of perioperative arrhythmias

Electrocardiography was the first application of electronic monitoring to anesthesia care. The detection of arrhythmias remains the most important use of this technology today. Several predisposing factors tend to emerge when perioperative arrhythmias are evaluated. These are the anesthetic given, the site of surgery, abnormalities of blood gases or electrolytes, tracheal intubation, reflexes such as vagal slowing and the oculocardiac reflex, stimulation of the central nervous system, the presence of preexisting heart disease, and the use of intracardiac devices. In the evaluation of cardiac arrhythmias, several facts need to be determined. The most important is to determine if there is an underlying complication of anesthesia and surgery that may explain the arrhythmia. In addition, it is vital to evaluate the heart rate, the regularity, the number of P waves per QRS, and the configuration of the QRS. The anesthesiologist needs to determine whether the rhythm is dangerous to the patient and whether it requires treatment. Prompt evaluation and management of perioperative arrhythmias reduce anesthetic morbidity and mortality. This article reviews the causes and pharmacological treatment of major abnormalities of atrial and ventricular cardiac arrhythmias occurring in the perioperative period.