CASE REPORT
Year : 2019  |  Volume : 13  |  Issue : 4  |  Page : 359-361

Epinephrine-induced electrical storm after aortic surgery


1 Department of Anesthesiology, UW School of Medicine and Public Health, Madison, WI, USA
2 Department of Anesthesiology and Critical Care Medicine, Albuquerque, NM, USA
3 Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR, USA

Correspondence Address:
Dr. Neal S Gerstein
Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine - MSC 10 6000; Albuquerque, NM - 87106
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.SJA_745_18

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Electrical storm (ES) is a potentially lethal syndrome defined as three or more sustained episodes of ventricular tachycardia or ventricular fibrillation within 24 h. There are multiple inciting factors for ES, one of which involves excess catecholamine (endogenous and exogenous) effects. Exogenous catecholamines used for hemodynamic support can paradoxically engender or exacerbate an underling arrhythmia leading to ES. We report on an 63-year-old man who presented for repair of an ascending aortic dissection. After cardiopulmonary bypass separation assisted with high-dose epinephrine, ES developed requiring over 40 defibrillatory shocks. The epinephrine infusion was held and within 5 min, the ES self-terminated. ES in the context of cardiovascular surgery with the use of epinephrine for hemodynamic support has not be previously reported. Clinicians need to be cognizant of the seemingly paradoxical effect of epinephrine to induce ES. Initial ES treatment involves acute stabilization (treating or removing exacerbating factors (i.e., excess catecholamines)).


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