RESUMO
Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. No antidote is available and management is based on the few cases that have been reported. The metabolism of flecainide is affected by both kidney and liver failure, which lead to accumulation of the drug. Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a woman with resolving sepsis with renal and hepatic complications.
Assuntos
Fibrilação Atrial/tratamento farmacológico , Flecainida/intoxicação , Complicações Intraoperatórias/tratamento farmacológico , Bloqueadores dos Canais de Sódio/intoxicação , Idoso , Amiodarona/uso terapêutico , Colecistectomia , Colecistite/complicações , Colecistite/cirurgia , Eletrocardiografia , Emergências , Feminino , Flecainida/sangue , Flecainida/farmacocinética , Flecainida/uso terapêutico , Humanos , Rim/metabolismo , Rim/fisiopatologia , Fígado/metabolismo , Fígado/fisiopatologia , Síndrome do QT Longo/induzido quimicamente , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/metabolismo , Complicações Pós-Operatórias/fisiopatologia , Edema Pulmonar/etiologia , Sepse/complicações , Sepse/metabolismo , Sepse/fisiopatologia , Bloqueadores dos Canais de Sódio/sangue , Bloqueadores dos Canais de Sódio/farmacocinética , Bloqueadores dos Canais de Sódio/uso terapêuticoRESUMO
En los últimos años se han desarrollado una serie de métodos no invasivos para poder detectar la aparición de un accidente vascular cerebral durante la cirugía carotídea. Estos métodos, basados en la monitorización del flujo sanguíneo (eco doppler transcraneal, oximetría cerebral) o en la actividad eléctrica cerebral (electroencefalograma, potenciales evocados, índice Biespectral) nos pueden aportan información sobre la posible afectación isquémica neuronal. Ninguno de ellos se ha podido constituir en el patrón oro de la monitorización, ya que tienen un elevado porcentaje de falsos positivos y negativos, incluso cuando se combinan entre sí. Aún está por encontrar y desarrollar el método más fiable y reproducible que sea capaz de detectar eventos perioperatorios que hasta ahora sólo se evidencian con el paciente vigil (AU)
In the last 30 years, some non invasive methods have developed to prevent and detect the occurrence of a stroke during carotid artery surgery. These methods, based mostly on monitoring blood flow (transcranial doppler, cerebral oximetry) and brain electrical activity (EEG, evoked potentials, bispectral index) give us information on the possible neuronal ischemic involvement. None of them has been able to build on the gold standard of monitoring, as they have a high percentage of false positives and negatives, even when mixed together. It remains to find and develop more reliable and reproducible method that is able to predict perioperative events that so far only the awake patient (AU)
Assuntos
Humanos , Monitorização Fisiológica/métodos , Doenças das Artérias Carótidas/cirurgia , Acidente Vascular Cerebral/prevenção & controle , Ultrassonografia Doppler Transcraniana/métodos , Oximetria/métodos , Eletroencefalografia/métodos , Potenciais EvocadosRESUMO
La flecainida es un antiarrítmico que actúa bloqueando los canales de sodio durante la fase 0 del potencial de acción, retardando la conducción cardiaca y disminuyendo la contractilidad. La intoxicación por este fármaco es muy infrecuente, con un inicio de acción rápido en forma de hipotensión y arritmias cardiacas y una alta mortalidad. No existe antídoto y su tratamiento está basado en la experiencia de los escasos casos descritos. Tanto la insuficiencia renal como hepática pueden alterar el metabolismo de la flecainida, lo que ocasiona acúmulo de la misma. Es recomendable no utilizar flecainida en este tipo de casos a menos que los beneficios claramente superen los riesgos de su utilización. En tales casos es indispensable la vigilancia clínica, electrocardiográfica y hemodinámica, así como la monitorización de niveles plasmáticos. Presentamos un caso de intoxicación por flecainida para tratamiento de fibrilación auricular en un paciente con un cuadro séptico en resolución, que sufría afectación hepática y renal(AU)
Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. No antidote is available and management is based on the few cases that have been reported. The metabolism of flecainide is affected by both kidney and liver failure, which lead to accumulation of the drug. Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a man with resolving sepsis with renal and hepatic complications(AU)