A 72yr old with no comorbidity was posted for Lumbar spine fixation Aparently ASA I and Airway OK had a Cardiology clearance for stable CV status at rest and Echo finding Degenarative AV and MV, diastolic dysfunction and Normal LV function. On OT table BP 140/93HR 59, Induced with Glyco Midaz, Pentazocin,Vec. ---> O2+N2O+Iso
5mins ,After the patient was turned and transfered to OT table, when the lines were fixed and monitor connected , it was found the pt has Hypotension and bradycardia but Spo2 100% ,subsequenrly 1+1+1 amps of atropine could hardly increased the HR to more than 60
As there was no significant change in status,for 15mins, We decided to cancel the surgery. as it is more disastrous to resucitate a patient in prone position, Brought back to Supine in the trolley, I cheked his preop ECG.HR was low with Left Axis deviation and poor progression of R from V2 to V6. I was told the patint was seen by another cardiologist who had advised for Coronary Angiogram, which pt refused and checked with other cardiologist
I did not try Isoprenaline or diluted adrenaline to raise HR. I did not find any heart block.
The pt was not reversed with Neostigmine but ventilates out slowly until muscle relaxation wares off.. By next 30min or so he was stable BP but still HR <85
Now the Question is why the Brady cardia was resistant to injection of Atropine,
What could be the possible cause in this
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