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A 14‐year‐old boy weighing 56 kg (body mass index‐24.49) with a history of rectal prolapse was posted for laparoscopic rectopexy under general anesthesia. Preanesthetic evaluation was unremarkable. He was premedicated in the preoperative area with 1 mg of intravenous (IV) midazolam. Anesthetic induction was done with 250 mg of IV thiopentone sodium, 100 μg of IV fentanyl, and 25 mg of IV atracurium. After securing the airway with a 7.0 mm uncuffed endotracheal tube, anesthesia was maintained with oxygen, air, isoflurane, and intermittent positive pressure ventilation. Ventricular ectopics with a heart rate of 70/min were observed on the monitor. There was no response to IV glycopyrrolate 0.2 μg, IV atropine 0.6 mg, or 50 mg of IV xylocard. Instead, it soon progressed to ventricular bigeminy with a blood pressure of 88/60 mmHg. The case was cancelled due to sustained arrhythmias. Postoperatively, the patient was hemodynamically stable with normal sinus rhythm. On further cardiac evaluation, he was found to have resting VPCs which disappeared on exercise. Echocardiography revealed a structurally normal heart. The child was started on oral metoprolol 25 mg twice daily as advised by the cardiologist.

Sustained ventricular arrhythmias in an asymptomatic child posted for laparoscopic rectopexy: An anesthetist's dilemma?