Conversion of first degree atrioventricular block (AV) to normal sinus rhythm (NSR) during propofol administration

초록

There are a few case reports describing conversion to NSR after a propofol injection in tachyarrythmic patients. However, this is a case of change of asymptomatic first degree AV block to NSR during propofol administration. A twenty eight-year-old male with palmar hyperhidrosis patient was presented for left T3 sympathicotomy. A week ago, he had undergone bilateral thoracoscopic T3 sympathicotomy. But hyperhidrosis of left hand was not cured. Preoperative ECG monitoring showed first degree AV block and infrequent Mobitz type II second degree AV block. A week ago, before bilateral T3 sympathicotomy, his ECG was NSR. After having prepared of external pacemaker, anesthesia was induced with propofol 2 mg/kg intravenous injection and continuous infusion of propofol at a rate of 150 ug/kg/min was started. PR interval was progressively shortened. 20 min after proopfol infusion. 188 ms of PR interval and 73 bpm of heart rate was achieved. After having left thoracoscopic T3 sympathicotomy NSR was maintained. This case suggests that propofol may have effect on autonomic tone or AV nodal conduction.