[Torsade de pointes associated with severe bradycardia after induction of general anesthesia].

An 80-year-old woman with chronic atrial flutter/fibrillation, and chronic renal failure underwent ileocecal resection. The preoperative electrocadiogram showed normal QT interval. Temporary pacemaker catheter was inserted for sinus arrest (5-6 sec) the day before operation. Anesthesia was induced with remifentanil 0.5 micro x kg(-1) min(-1), thiamylal 125 mg, and rocuronium 30 mg after intravenous atropine sulfate 0.5 mg. Because the heart rate was increased with atropine sulfate, the pacemaker was not started. Anesthesia was then maintained with intravenous remifentanil and sevoflurane-air-oxygen. Just after induction of anesthesia, sinus bradycardia occurred, and 9 minutes after tracheal intubation, ECG suddenly showed torsade de pointes (TdP) and the arterial blood pressure decreased leading to asystole. We immediately started cardiopulmonary resuscitation, and TdP stopped spontaneously within 1 minute. We started pacemaker (VVI, 60 beats x min(-1)) and intravenous injection of lidocaine, and TdP did not recur. In this case, TdP seemed to have occurred because of bradycardia-induced abnormal QT prolongation. This should be considered the risk of lethal arrhythmia in patients with severe bradycardia including TdP.