P020: USE OF EMERGENCY MANUALS TO TREAT INTRAOPERATIVE SUPRAVENTRICULAR TACHYCARDIA AND HYPTOENSION DURING EXPLORATIVE LAPAROTOMY: CASE REPORT
Daniel Eskander, MD; Jeffrey Huang, MD; HCA healthcare/University of South Florida Morsani College of Medicine GME consortium
We present a 89-year-old male with a history of hypertension. atrial fibrillation and coronary artery disease with an ejection fraction of 35% who presents for exploratory laparotomy for possible small bowel obstruction. Three hours intraoperative, after an uneventful induction with etomidate and rocuronium, patient entered an episode of atrial tachycardia and became hypotensive with a blood pressure 65/40. Multiple doses of 100 mcg bolus of phenylephrine exacerbated the tachycardia and would result in a further decreased blood pressure. Emergency manual for superventricualar tachycardia was used to guide therapy and blood pressure was stabilized using 20mg of esmolol which would temporarily resolve tachycardia and restore mean arterial pressure (MAP) to >65. Patient was placed on an esmolol drip to maintain MAP for the remaining operative time and continued to require for hemodynamic stability in post anesthesia care unit where he was eventually transferred to Intensive Care.