ABSTRACT
Gastrointestinal A N TIEM ETIC S DROPERIDOL: INTERACTIO N W ITH C YC LO BENZAPRINE AND FLUOXETINE: TO RSADE DE POINTES
Approximately two hours postsurgery for Achilles tendon repair, a 59year-old woman developed polymorphic ventricular tachycardia (torsade de pointes) which progressed into ventricular fibrillation. Preadmission medica tions included amlodipine (5 mg daily), cyclobenzaprine (10 mg daily), diclo fenac (100 mg daily), fluoxetine (30 mg daily), and triamterene/HCTZ (37.5 mg/25 mg daily). Preoperative medications included intravenous cefazolin (1 g three hours preop), droperidol (0.625 mg, 45 min prior to surgery), and metoclopramide (10 mg, 45 min prior to surgery). Cardiopulmonary resuscita tion also included intravenous atropine (1 mg), lidocaine bolus (50 mg) and infusion (2 mg/min), and magnesium sulfate (4 mg). An ECG revealed a prolonged QTc (500 msec) without ischemic event. One day post-surgery the QT was 440 msec, and ECG revealed normal sinus rhythm, and electrolytes and thyroid panel were within normal range. Although total creatine phosphokinase was elevated (629 U/L), the MB fraction was not (0%). The patient was discharged on post-operative day six without further event. All preoperative medications except cyclobenzaprine were restarted.