arrhythmias (fitness for anaesthesia)
Last reviewed 01/2018
Anaesthetic agents may sensitise the myocardium to the catecholamines released under stress: life-threatening arrhythmias such as ventricular fibrillation can be precipitated.
Some general guidelines at the preoperative anaesthetic assessment:
- atrial fibrillation: try to get the apical rate less than 100bpm and the radial rate not more than 20bpm less
- ventricular ectopics - any more than two of the following criteria may require the patient to be treated beforehand with an antiarrhythmic:
- runs of three or more
- ectopics occurring more than once in 4-5 beats
- multifocal ectopics
- 'R on T' phenomena
- heart block:
- 1st degree is acceptable
- 2nd degree:
- type I - no implication for general anaesthesia
- type II - pace because risk of heart block
- 3rd degree: pacing required