Anaesthesiological management of perioperative cardiac arrhythmias

Cardiac arrhythmias play an important role in perioperative medicine in add ition to coronary heart disease and cardiac low output syndrome. Although i ncidence of severe complications associated with arrhythmias is low, profou nd knowledge in pathophysiology and therapy of arrhythmias is essential for anaesthesiologists. Only this allows exact risk evaluation and proper sele ction of specific therapeutical measures. This article presents first an exact classification of the different types of cardiac arrhythmias such as bradycardia or tachycardia and then addresse s the typical triggers of arrhythmias in the perioperative setting. The fol lowing part presents fundamental pathophysiological and pharmacological asp ects, before outlining diagnostic and therapeutical procedures in cases of preexisting or acute cardiac arrhythmias in the pre-, intra- and postoperat ive setting. In addition to basic measures for prevention and therapy, specific approach es selective pharmacological or electrical treatment of different types of arrhythmias such as bradycardia or tachycardia are given. This should provide support for the anaesthesiologist particularly in the a cute management of arrhythmias. Besides it should also facilitate practical handling of severe or even life-threatening complications associated with these arrhythmias.