Vascular Interventional Radiologists (VIRs) frequently care for patients with high severity of illness, multiple comorbidities, and physiologic derangements. The incidence and prevalence of abnormal cardiac rhythms (dysrhythmias) in these patients is high, and these can quickly lead to hemodynamic instability, shock, and death. Therefore, VIRs should be skilled in the evaluation and management of common dysrhythmias. Here, we provide an overview of commonly encountered narrow-complex tachycardias, wide-complex tachycardias, and bradycardias, with emphasis on recognition, diagnosis of underlying etiologies, and initial pharmacologic or electrical treatment steps, with the understanding that advanced treatment and long-term management should be undertaken in conjunction with electrophysiology expertise.

Background Effective and complete reversal of neuromuscular blockade is essential for safe recovery from general anesthesia. This becomes more significant in patients undergoing cardiac procedures as they have limited cardiopulmonary reserve and reduced tolerance for physiological instability. Neostigmine is the conventional agent of choice for the reversal of non-depolarizing neuromuscular blockade. However, its use is associated with variable efficacy and unwanted side effects such as bradycardia and bronchoconstriction. Sugammadex, a novel relaxant binding agent, reverses neuromuscular blockade by encapsulating free rocuronium molecules, thereby rapidly diminishing their functional presence at the neuromuscular junction. Compared with neostigmine, sugammadex has demonstrated accelerated and more predictable reversal, including from a deeper level of blockade. Materials and methods The current study is a prospective, randomized, triple-blinded interventional study done for a period of one year in a tertiary care hospital in India. Fifty adult patients scheduled for an elective cardiac catheterization procedure under general anesthesia were randomized into two equal groups (n=25 each) to receive either sugammadex or neostigmine for the reversal of neuromuscular blockade. The primary aim was to compare the efficacy and safety of sugammadex and neostigmine in reversing moderate neuromuscular blockade, defined as the reappearance of the second twitch (T2) on train-of-four (TOF) monitoring until the attainment of a TOF ratio of ≥0.9, in adult patients undergoing cardiac catheterization procedures under general anesthesia. Secondary objectives included evaluating adverse event profiles and time to discharge readiness from the post-anesthesia care unit (PACU) using the modified Aldrete score. Results The mean time from the reappearance of the second twitch (T2) on TOF monitoring until the attainment of a TOF ratio of ≥0.9 was significantly shorter in the sugammadex group as compared to the neostigmine group (t=14.42; p<0.001). Time to PACU discharge readiness was also significantly reduced with sugammadex (50.24±17.89 minutes) compared with neostigmine (65±15.45 minutes; t=3.15; p=0.002). Adverse effects occurred less frequently in the sugammadex group. Conclusion Sugammadex provides a swifter, more predictable, and safer reversal of neuromuscular blockade compared with neostigmine in patients undergoing cardiac catheterization procedures. Sugammadex facilitates earlier recovery and improved postoperative outcomes in the cath lab setting.

The trigeminocardiac reflex (TCR) is an autonomic reflex elicited by stimulation of the trigeminal nerve and is most commonly characterized by bradycardia and hypotension. In oral and maxillofacial surgery, peripheral TCR may occur during manipulation of the maxillary or mandibular divisions, occasionally presenting with atypical cardiovascular responses. We report a rare case of peripheral TCR manifesting as sudden severe hypertension with ventricular bigeminy during wide local excision and marginal mandibulectomy in a 69-year-old male with carcinoma of the lower alveolus. The hemodynamic disturbance coincided with the traction and suturing of the mandibular alveolar margin and was refractory to pharmacological management. Prompt release of surgical traction resulted in immediate resolution of both hypertension and arrhythmia, with no postoperative cardiac sequelae. This case underscores the importance of recognizing atypical presentations of TCR in maxillofacial procedures and highlights the need for close anesthetic-surgical communication and gentle tissue handling to prevent potentially life-threatening complications.

The wake-up test (WKT) is an important intraoperative method for assessing spinal cord function during scoliosis surgery, particularly in settings where intraoperative neurophysiological monitoring (IONM) is unavailable. This short case series describes seven patients undergoing scoliosis surgery with a modified wake-up test (mWKT). Sugammadex was used to reverse neuromuscular blockade to facilitate motor assessment. All patients were able to follow commands and demonstrate lower-limb movement during the test. The duration of mWKT ranged from 15 to 35 min and decreased with increasing procedural familiarity. One patient required naloxone due to delayed recovery. Importantly, no episodes of bradycardia or clinically significant hemodynamic instability were observed following sugammadex administration. Only one patient reported limited postoperative recall. This case series suggests that the WKT remains a feasible and safe alternative when IONM is unavailable. Sugammadex may facilitate more efficient neuromuscular recovery and improve procedural control.