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Case Reports in Anesthesiology
Volume 2013, Article ID 852143, 3 pages
http://dx.doi.org/10.1155/2013/852143
Case Report

Mobitz Type II Atrioventricular Block Followed by Remifentanil in a Patient with Severe Aortic Stenosis

Anesthesia Department, Imam-Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Received 23 January 2013; Accepted 18 February 2013

Academic Editors: U. Buyukkocak, M. R. Chakravarthy, and J. Malek

Copyright © 2013 Mehryar Taghavi Gilani and Majid Razavi. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Opioids have been considered for their hemodynamic stability. Remifentanil is an opioid analgesic with rapid metabolism and fast primary effect and recovery. In this paper, a very rare effect of using remifentanil along with propofol was presented. An 84-year-old male patient with severe aortic stenosis underwent general anesthesia. In order to induce anesthesia and maintain it, fentanyl, pancuronium, and propofol, along with a combination of propofol and remifentanil, were used, respectively. At beginning of remifentanil infusion, bradycardia and then Mobitz type II conduction block with a hemodynamic disorder occurred for the patient. The decreased blood pressure responded to injection of atropine and ephedrine; however, dysrhythmia only improved after cessation of remifentanil. Therefore remifentanil should be used with caution in aortic stenosis.