frequent PVC's under GA

[apma77]

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patient with a prior history of CAD but a clean preop EKG..how do you guys approach new frequent PVC's on the EKG during a GA case assuming the patient is hemodynamically stable..any thought?

i usually give 100mg lidocaine and some magnesium.

just wondering what you guys do???

 

[smgilles]

patient with a prior history of CAD but a clean preop EKG..how do you guys approach new frequent PVC's on the EKG during a GA case assuming the patient is hemodynamically stable..any thought?

i usually give 100mg lidocaine and some magnesium.

just wondering what you guys do???

Why give anything for asymptomatic PVC's?

 

[SleepIsGood]

Why give anything for asymptomatic PVC's?

ditto....

technically if i recall correctly you dont have to worry about them unless 3-4 of them occur back to back. i dont remember though.

 

[Planktonmd]

patient with a prior history of CAD but a clean preop EKG..how do you guys approach new frequent PVC's on the EKG during a GA case assuming the patient is hemodynamically stable..any thought?

i usually give 100mg lidocaine and some magnesium.

just wondering what you guys do???

New PVC's that were not there before could mean many things:
Ischemia, hypercarbia, hypoxia, light anesthesia....
You need to make sure you are not missing one of these things.

 

[dfk]

i've seen irritability by using Des.
after switching from Des to something else,
usually tachy/arrhythmias resolve

 

[jwk]

patient with a prior history of CAD but a clean preop EKG..how do you guys approach new frequent PVC's on the EKG during a GA case assuming the patient is hemodynamically stable..any thought?

i usually give 100mg lidocaine and some magnesium.

just wondering what you guys do???

I'd probably give the lidocaine, but that's more old habits than anything. If they're unifocal and the patient is otherwise hemodynamically stable, I wouldn't do anything else.

3 PVC's back to back by definition is V-tach, although most people would probably just call it 3 PVC's back to back. That, however, would definitely raise my eyebrow a lot higher than the frequent but unifocal PVC's.

 

[Planktonmd]

I'd probably give the lidocaine, but that's more old habits than anything. If they're unifocal and the patient is otherwise hemodynamically stable, I wouldn't do anything else.

The question is always why someone who was not having PVC's preop is having them now?
99% it's nothing and since there is no hemodynamic effects it does not require specific treatment.
BUT, in 1% it might be something more serious and you need to treat the cause not the symptom.
In other words, you need to go through a checklist of possible causes and make sure you are not missing something.
Otherwise, giving lidocaine to treat monomorphic asymptomatic PVC's is an attempt to hide a symptom of an unknown problem.

 

[militarymd]

cast trial

 

[Noyac]

cast trial

Are you saying not to treat them?

http://www.ncbi.nlm.nih.gov/pubmed/1372950?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&dbfrom=pubmed

These studies are dealing with post-MI pts. How do they relate to PVC's under GA?

 

[militarymd]

I'm saying that once you rule out the bad stuff....it probably doesn't matter what you do....especially with drugs that were studied.

Patient population maybe different, but I would consider post mi patients at higher risk of having problems than your garden variety patient.


My take on studies is that if it is OK with higher risk patients, then it is ok for lower risk patient.

Are you saying not to treat them?

http://www.ncbi.nlm.nih.gov/pubmed/1372950?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&dbfrom=pubmed

These studies are dealing with post-MI pts. How do they relate to PVC's under GA?

 

[Planktonmd]

It's difficult for me to say it but here it goes:
I agree with MMD here!

 

[toughlife]

It's difficult for me to say it but here it goes:
I agree with MMD here!

 

[militarymd]

It's difficult for me to say it but here it goes:
I agree with MMD here!

.....that's why when I agreed with plank in the thread about compartment syndrome....I tried to pretend like I was saying something different than him.

 

[Noyac]

I'm saying that once you rule out the bad stuff....it probably doesn't matter what you do....especially with drugs that were studied.

Patient population maybe different, but I would consider post mi patients at higher risk of having problems than your garden variety patient.


My take on studies is that if it is OK with higher risk patients, then it is ok for lower risk patient.

Thats ridiculous. Someone that doesn't normally have PVC's is now having them and you are saying that it is fine.

It is absolutely not OK.

See following post.

 

[Noyac]

Just Kidding 😉

 

[jetproppilot]

I'd probably give the lidocaine, but that's more old habits than anything. If they're unifocal and the patient is otherwise hemodynamically stable, I wouldn't do anything else.

3 PVC's back to back by definition is V-tach, although most people would probably just call it 3 PVC's back to back. That, however, would definitely raise my eyebrow a lot higher than the frequent but unifocal PVC's.

Agree wholeheartedly with JWK.

Frequent PVCs would warrant a shot of lidocaine, probably to make me feel better than anything else.

V tach, albeit only 3-in-a-row, would summons a cardiologist visit in the PACU.

 

[Noyac]

By the way I use Mg 2 gms.

 

[2win]

By the way I use Mg 2 gms.

Mg - my choice too.I r/o electrolyte problems with an abg. I had this discussion with a cardio guy ( well known) and he said that's the choice. Regarding Lido - old habit, not harmfull though ( the problem with the treshold for defib. is arguable). There is the fine line - to react or overreact. Usually I over... Keep the patient in IMCU with Holter for 24 h, check some troponines. The risk is to be called "the newbie" if everything is OK. The advantage - avoidance of an M&M...and a night of good sleep.