Intraoperative Atrial Fibrillation: An Anesthetic Challenge - A Safe Outcome Saves the Day.

Patient with prosthetic heart valves are a challenge to the anesthesiologist. Atrial arrhythmias may occur in a patient with preexisting cardiac condition. An elderly male patient with history of double valve replacement with rate controlled atrial fibrillation was taken up for open nephrectomy. Throughout the intraoperative period, hemodynamic instability was managed using inotropes. However, at the end of the procedure, patient had sudden episode of tachyarrhythmia with hypotension which was diagnosed as unstable atrial fibrillation (AF) and direct cardioversion was done which reverted the rhythm to normal. Patient was shifted to intensive care unit for observation and further management, where he was extubated after 24 hours.