Let's say you are doing a case and your pt goes into A fib.
What's your treatment approach?
What if your pt has had A fib in the past and is scheduled for a long case. Do you do anything to prevent it from occurring?
If AFib, I don't dream about rhythm control, just rate control till the surgery is done. A high percentage of new onset AFibs will convert back to sinus on their own.
If RVR, I would try an esmolol drip, see how it works. If not, try diltiazem on a pump (that's what I used to in internship). Obviously, if the patient is unstable, electrical cardioversion. I have never used amio, so I am not sure I would try it intraop, unless I had no other choice.
Also, I would tell the surgeon immediately about the AFib and the need to finish the surgery as soon as possible (i.e. no teaching). I would also check if there any sympathetic stimulants I could fix, that could be related to the AFib (HTN, hypervolemia, hypercarbia, inadequate anesthesia etc.). I might get blood for electrolytes and cardiac enzymes. I would also watch out for PE and MI (a cardiac echo would be nice if available), and let the surgeon know that one of these could be the potential cause (so hurry up).
If the patient had recurring AFib in the past and it's a long case, I would try to find out what prompted it and what it responded to. Maybe even put Zoll pads on. Again, I would try to avoid any potential precipitating factor.