Anaesthetic Management of a Case of Multiple Ventricular Premature Contraction Posted for Spine Surgery: A Case Report

Shaista Jamil, Poonam Singh, Abad Khan, Nupoor

Abstract: Ventricular premature contractions (VPCs) are ectopic beats arising from the ventricular myocardium below the AV node. VPCs which are occasional and presents with no symptoms are very common in daily clinical practice. However, VPCs which are multiple (>5) or are associated with cardiac anomalies can progress to life threatening arrhythmias. Inhalational agents, electrolyte and metabolic abnormalities under anaesthesia can precipitate multiple VPCs. Here, we present a case of a 29 years old male patient with occasional VPCs posted for implant removal of lumbar spine in our institution. After 30 minutes of starting surgery under general anaesthesia, patient developed multiple VPCs with hemodynamic instability which was managed successfully by prompt treatment with injection loxicard and injection metoprolol iv. and surgery went uneventful. This case report highlights various factors which could precipitate VPCs under anaesthesia and concludes that judicious and prompt use of anti - arrhythmic agents can prevent an asymptomatic VPCs transforming into fatal arrhythmias.

Keywords: Ventricular premature contraction, arrhythmias, Holter, ECHO, Hypoxia, hypokalemia