Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Atropine Induced Paradoxical Atrioventricular Conduction Block in a Jindo Dog

진도종 개에서 아트로핀에 의해 발생한 역설적 방실 전도 차단

  • Lee, Moo-Hyun (Section of Small Animal Internal Medicine, School of Veterinary Medicine, Kangwon National University) ;
  • Lee, Seung-Gon (Section of Small Animal Internal Medicine, School of Veterinary Medicine, Kangwon National University) ;
  • Moon, Hyeong-Sun (Section of Small Animal Internal Medicine, School of Veterinary Medicine, Kangwon National University) ;
  • Lee, Joon-Seok (Section of Small Animal Internal Medicine, School of Veterinary Medicine, Kangwon National University) ;
  • Lee, Lyon (Western University, Graduate University of Medical Science) ;
  • Hyun, Chang-Baig (Section of Small Animal Internal Medicine, School of Veterinary Medicine, Kangwon National University)
  • 이무현 (강원대학교 수의(학부)대학 소동물 내과교실) ;
  • 이승곤 (강원대학교 수의(학부)대학 소동물 내과교실) ;
  • 문형선 (강원대학교 수의(학부)대학 소동물 내과교실) ;
  • 이준석 (강원대학교 수의(학부)대학 소동물 내과교실) ;
  • 이용훈 (미국 웨스턴 대학교 수의학과) ;
  • 현창백 (강원대학교 수의(학부)대학 소동물 내과교실)
  • Published : 2007.09.30
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Abstract

A 6-month-old intact male Jindo dog was underwent surgery for hip fracture caused by hit by a car. Routine laboratory tests performed prior to surgery found no significant abnormalities, which might increase risks associated with general anesthesia. The dog was premedicated with atropine, induced general anesthesia with thiopental sodium and maintained with isoflurane. Forty minutes after surgery, the dog was suddenly bradycardic. Atropine (18 ug/kg) was slowly infused intravenously to normalize heart rate. However, paradoxically the dog showed slower heart rate with intermittent atrioventricular block ($2^{nd}$ degree type I) after atropine infusion. The dog's rhythm was returned to normal rate 7 minutes after ephedrine was infused. This is a rare case of paradoxical atrioventricular block induced by high dose of atropine in a dog.

6개월령 수컷 진도종 개가 교통사고에 의한 골반 골절 교정술을 위하여 내원하였다. 일반적인 수술 전 검사에서 마취와 관련해 위험성 있는 이상은 발견되지 않았다. 이 개는 아트로핀으로 전처치하고, 유도마취로 thiopental을 주사하였으며 유지 마취 약물로 isoflurane을 사용하였다. 수술 시작 40분 후 갑자기 서맥이 발생하여 아트로핀(18ug/kg)을 천천히 정맥주사 하였으나 즉시 맥박이 증가하지 않고 오히려 heart rate가 감소하며 방실 전도 차단($2^{nd}$ degree type I)이 발생하였다. 따라서 ephedrin을 즉각적으로 주사하였으며, 투여 7분 후 정상 심박으로 회복되었다. 본 증례는 개에서 고용량 atropine 투여로 드물게 발생하는 역설적 방실전도 차단 임상예이다.

Keywords

References

  1. Barold SS. 2:1 Atrioventricular block: order from chaos. Am J Emerg Med 2001; 19: 214-217 https://doi.org/10.1053/ajem.2001.21715
  2. Bernheim A, Fatio R, Kiowski W, Weilenmann D, Rickli H, Brunner-La Rocca HP. Atropine often results in complete atrioventricular block or sinus arrest after cardiac transplantation: an unpredictable and dose-independent phenomenon. Transplantation 2004; 77: 1181-1185 https://doi.org/10.1097/01.TP.0000122416.70287.D9
  3. Castellanos A, Garcia HG, Rozanski JJ, Zaman L, Petkaros K, Myerburg RJ. Atropine-induced multilevel block in acute inferior myocardial infarction. A possible indication for prophylactic pacing. Pacing Clin Electrophysiol 1981; 4: 528-537 https://doi.org/10.1111/j.1540-8159.1981.tb06224.x
  4. Das G. Cardiac effects of atropine in man: an update. Int J Clin Pharma Therap 1989; 27: 473-477
  5. Koh J, Brown TE, Beightol LA, Ha CY, Eckberg DL. Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic patients. J Physiol (Lond). 1994; 474: 483-495 https://doi.org/10.1113/jphysiol.1994.sp020039
  6. Lim HH, Ho KM, Choi WY, Teoh GS, Chiu KY. The use of intravenous atropine after a saline infusion in the prevention of spinal anesthesia-induced hypotension in elderly patients. Anesth Analg 2000; 91: 1203-1206 https://doi.org/10.1097/00000539-200011000-00029
  7. List WJ, Gravenstein JS. Effects of atropine and scopolamine on the cardiovascular system in man. Anesthesiology 1965; 26: 299-304 https://doi.org/10.1097/00000542-196505000-00005
  8. McGuigan H. The effect of small dose of atropine on the heart rate. JAMA. 1921; 76: 1338 -1340 https://doi.org/10.1001/jama.1921.02630200010007
  9. Montano N, Cogliati C, Porta A, Pagani M, Malliani A,Narkiewicz K, Abboud FM, Birkett C, Somers VK. Central Vagotonic Effects of Atropine Modulate Spectral Oscillations of Sympathetic Nerve Activity. Circulation 1998; 98; 1394-1399 https://doi.org/10.1161/01.CIR.98.14.1394
  10. Morton HJ, Thomas ET. Effect of atropine on the heartrate. Lancet. 1958; 2: 1313-1315
  11. Muir WW. Effects of atropine on cardiac rate and rhythm in dogs. J Am Vet Med Assoc. 1978; 172: 917-921
  12. Pomeranz M, Macaulay RJB, Caudill MA, Kutz I, Adam D, Gordon D, Kilborn KM, Barger AC, Shannon DC, Cohen RJ. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol. 1985; 248: HI51-HI53
  13. Raczkowska M, Eckberg DL, Ebert TJ. Muscarinic cholinergic receptors modulate vagal cardiac responses in man. J Auton Nerv Syst. 1983; 7: 271-278 https://doi.org/10.1016/0165-1838(83)90080-2
  14. Richards DLS, Clution RE, Boyd C. Electrocardiographic findings following intravenous glycopyrrolate to sedated dogs: A comparison with atropine. J Assoc Vet Anaesth. 1989; 16: 46-50 https://doi.org/10.1111/j.1467-2995.1989.tb00071.x