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Torsades de pointes secondary to intravenous haloperidol after coronary bypass grafting surgery

From the Departments of Surgery and Anesthesia, Montreal Heart Institute, Montreal, Quebec.

Address correspondence to: Louis P. Perrault MD PhD, Research Center, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec, HIT I C8 Canada. Phone: 514-376-3330; Fax: 514-376-1355; E-mail: lpperrau{at}icm.umontreal.ca

Purpose: Postoperative delirium occurs in about 2% of patients undergoing major cardiac surgery including coronary artery bypass grafting surgery (CABG). Haloperidol (Sabex, Boucherville, Canada) is a drug commonly used in the intensive care unit for the treatment of delirium and is usually considered safe even at high doses and is rarely implicated in the development of malignant ventricular arrhythmias such as torsades de pointes. The purpose of this study is to report such a complication of use of haloperidol after myocardial revascularization.

Clinical features: The patient reported underwent uneventful triple bypass surgery. Administration of large intravenous doses of haloperidol was necessary for control of psychomotor agitation due to delirium. Torsades de pointes occurred in the absence of QT prolongation on the third postoperative day following use of the drug with no other obvious etiological factor.

Conclusion: Awareness of this rare complication is key to judicious use of this drug in the post CABG patient in whom such an arrhythmia may have very deleterious consequences because of the underlying cardiac condition.

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