Abstract

ARRHYTHMIA FOLLOWING MIDAZOLAM: PHARMACOKINETICS OR PHARMACOGENOMICS?

Dr. Mitragotri Milon V., Dr. Kurdi Madhuri S., Dr. Yalagachin Gurushantappa H., Dr. Kallapur Basavaraj G

ABSTRACT

Midazolam is an imidazole-benzodiazepine compound used to allay anxiety, induce sedation and amnesia to patients undergoing surgeries under general anaesthesia. It is used occasionally prior to regional anaesthesia as an anxiolytic. We report a case of life threatening arrhythmia following midazolam premedication. A 65 year old otherwise healthy male with good effort tolerance and a pre -hypertensive blood pressure (BP) of 136/86mmHg was scheduled first on the list for fistulectomy under subarachnoid anaesthesia. Monitors were attached. (Pulse, non-invasive blood pressure and pulse oximetry) Intravenous (IV) infusion of ringer lactate(RL) was started. The initial heart rate and BP recorded were 76 per minute and 160/100mmHg respectively. Considering this BP to be due to anxiety, 1mg midazolam, freshly loaded, was given as a bolus intravenously. Patient became restless within a minute following it. Monitor displayed polymorphic ventricular tachycardia followed a few seconds later by bradycardia. (heart rate

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