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Ann Thorac Surg 1991;52:534-536
© 1991 The Society of Thoracic Surgeons


Articles

Bezold-Jarisch reflex in postoperative pediatric cardiac surgical patients

David A. Fullerton, MD*, John A.St. Cyr, MD, PhD, David R. Clarke, MD, David N. Campbell, MD, Warren H. Toews, MD, W.Mike See, MD

Department of Surgery, University of Colorado Health Sciences Center, and Division of Pediatric Cardiology, The Children's Hospital, Denver, Colorado, USA

Accepted for publication May 15, 1991.

* Address reprint requests to Dr Fullerton, Department of Surgery, University of Colorado Health Sciences Center, Campus Box C-310, 4200 East 9th Ave, Denver, CO 80262.

The Bezold-Jarisch reflex is an inhibitory reflex that originates from the heart, is mediated by the vagus nerve, and is manifested by hypotension and bradycardia. We present 4 pediatric cardiac surgical patients, aged 1 day to 9 months, who exhibited cardiovascular collapse in their early postoperative course. In each patient, cardiovascular deterioration was marked by an insidious decrease in arterial blood pressure without an associated change in heart rate, central venous pressure, or airway pressure. Bradycardiai followed the decrease in blood pressure. The Bezold-Jarisch reflex was suspected and atropine was administered, first as a bolus injection at 0.01 mg/kg, and later, as a continuous infusion at 0.01 mg · kg–1 · h–1. Atropine prevented recurrent episodes of hypotension and bradycardia. We believe the Bezold-Jarisch reflex is more prevalent than previously suspected in postoperative pediatric cardiac surgical patients.




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