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Canadian Journal of Anesthesia, Vol 32, 654-657, Copyright © 1985 by Canadian Anesthesiologists' Society

Recurrence of Pulsus Alternans after Fentanyl Injection in a Patient with Aortic Stenosis and Congestive Heart Failure

ANDREW B. FREEMAN MD1 and RICHARD A. STEINBROOK MD1

1 Departments of Anaesthesia, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

Address correspondence to: Dr. Richard A. Steinbrook, Department of Anesthesia, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Following aortic valve replacement in a patient with aortic stenosis and cardiac failure, marked pulsus alternans recurred immediately after intravenous injection of 0.5 mg fentanyl, without concomitant changes in heart rate, mean left atrial pressure, or the electrocardiogram. Pulsus alternans is known to occur in association with heart failure and aortic stenosis, but has not been reported previously in response to anaesthetic drugs. Mechanisms of pulsus alternans are discussed, and the possible contributory role of fentanyl is considered.

Key Words: ANALGESICS: fentanyl • SURGERY: cardiac • BLOOD PRESSURE: drug effects, fentanyl






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Copyright © 1985 by the Canadian Anesthesiologists' Society.