Patient (condition)
 
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Does the patient have a pacemaker? Bradyarrhythmias requiring pacemaker insertion are common.

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Be aware that light anesthesia, hypotension and hypovolemia does not usually result in tachycardia in the denervated heart. Other indicators for the above will need to be utilised.

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Consider the risk of cardiac transplant vasculopathy. This is a process of diffuse, concentric intimal hyperplasia of coronary arteries present in up to 50% of patients after 10 years. Check most recent angiography results, and manage intraoperatively as you would for a patient with ischaemic heart disease. #ref

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Anticholinergics will not have their expected effect due to the autonomic denervation of the transplanted heart.

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Direct sympathomimetics and beta 1 antagonists will have their normal expected action. ( adrenaline, dobutamine, beta blockers)

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When reversing muscle relaxation with neostigmine it may be tempting to not co-administer anticholinergics such as atropine or glycopyrollate due to the dennervated nature of the transplanted heart, however there are several case reports of sinus arrest in patients being adminstered neostigmine alone.

journals.lww.com/anesthes...

Sinus Arrest After Intravenous Neostigmine in Two Heart Transplant Recipients.

Beebe, David S. MD; Shumway, Sara J. MD; Maddock, Robert MD
Anesthesia & Analgesia:
April 1994 - Volume 78 - Issue 4 - ppg 779-782

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