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LETTER TO THE EDITOR
Year : 2011  |  Volume : 27  |  Issue : 3  |  Page : 421

Authors' reply


Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication11-Aug-2011

Correspondence Address:
Girija Prasad Rath
Associate Professor, Department of Neuroanaesthesiology, Neurosciences Centre, 6th Floor/ Room No. 9 A.I.I.M.S., New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 21897533

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How to cite this article:
Dube SK, Bharti SJ, Rath GP. Authors' reply. J Anaesthesiol Clin Pharmacol 2011;27:421

How to cite this URL:
Dube SK, Bharti SJ, Rath GP. Authors' reply. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 May 27];27:421. Available from: http://www.joacp.org/text.asp?2011/27/3/421/83706

Sir,

Thank you for your interest and valuable comments on our article on ventricular premature contractions (VPCs) under anesthesia in prone position. [1] We do agree that carinal irritations at times cause VPCs. However, bradycardia and VPCs secondary to carinal stimulation are known to occur mostly in hemodynamically unstable patients with coexisting hypoxemia, and in patients under light plane of anesthesia.[2] These possibilities were ruled out prior to administration of lignocaine in our case. Both, tracheal tube displacement and light plane of anesthesia, should have altered the airway pressure to some extent, which was not seen in this case.

We tried to find out the cause of these VPCs with the help of 12-lead ECG and arterial blood gas analysis, and took the opinion of a cardiologist. Other common causes of VPCs like coronary artery disease and myocardial infarction were also ruled out. The hemodynamic parameters of the patient were observed intraoperatively for 30 minutes, and were found to be normal. Moreover, the patient was evaluated for the cause(s) of arrhythmia during the postoperative period.

All inhalational agents have arrhythmogenic potential. Although we implicated isoflurane as the possible cause of intraoperative VPCs, lignocaine infusion was used to treat it, rather than a change in anesthetic technique, as there was no associated hemodynamic instability. We would like emphasize that, transient episodes of VPCs, without any hemodynamic changes may not be pathological and hence, should not be the reason for cancellation of surgery in an otherwise healthy individual.

 
   References Top

1.Dube SK, Bharti SJ, Rath GP. Frequent ventricular premature contractions under anaesthesia in prone position. Indian J Anaesth 2011;27:128-45.  Back to cited text no. 1
    
2.Burman SO, Gibson TC, Chir B. Bronchoscopy and cardiorespiratory reflexes. Ann Surg 1963;157:134-41.  Back to cited text no. 2
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