If there is a tachyarrhythmia, correct any predisposing factors (e.g. light

anaesthesia, hypokalaemia, hypomagnesaemia) and slow down the HR as

appropriate. For example, fast AF may require amiodarone to treat it, or even

a synchronized DC shock.

A bradycardia should be treated by reversing the cause in the first instance.

Severe hypoxia causes bradycardia and should be rapidly reversed. Some

surgical procedures may cause vagal stimulation (e.g. anal dilatation, testicular

traction, strabismus surgery, laparoscopy).

Where possible, ask the surgeon to stop. Anticholinergics, such as atropine

and glycopyrrolate are very useful. Unremitting bradycardia can be treated

with ephedrine, adrenaline, glucagon, pacing. Remember a high spinal can

also cause bradycardia by affecting the sympathetic innervation to the heart

(T1 –T4)

Critical Hypotension