LETTER TO THE EDITOR Transient ventricular flutter in Devic’s syndrome during hysteroscopy under anesthesia Gokcen Basaranoglu • Mefkur Bakan • Tarik Umutoglu • Ufuk Topuz • Ziya Salihoglu Received: 10 June 2014 / Accepted: 4 November 2014 Ó Springer-Verlag Italia 2014 Editor, Neuromyelitis optica, also known as Devic’s syndrome, is a rare, idiopathic relapsing demyelinating disease of the central nervous system first described by Devic in 1894 [1]. Both neuraxial and general anesthesia have been described in the literature for this condition [2, 3]. In this case, a patient with Devic’s syndrome experienced two episodes of transient ventricular flutter during hysteroscopy, while under general anesthesia. She gave written informed con- sent for the publication of this report. The patient, a 37-year-old woman, 162 cm tall and weighing 72 kg, was scheduled for polyp resection under hysteroscopy. For the past 9 years, she has suffered from relapsing scapular numbness, lower extremity paresthesia, and weakness. Magnetic resonance imaging of the spine revealed a hyperintense lesion from levels C7 to T2 of the spinal cord, leading to the diagnosis of transverse myelitis. Devic’s syndrome was diagnosed 4 years ago by means of a positive serology testing for Anti-aquaporin-4. She was treated with azathioprine. According to her medical history, she also had had an intracranial hematoma 3 years before the surgery. The preoperative laboratory test results were within normal ranges. During the preoperative period, the patient expressed her anxiety. After routine monitor- ization with electrocardiogram, peripheral oxygen satura- tion, and noninvasive arterial blood pressure, midazolam 2 mg and fentanyl 50 lg were administered as premedi- cation. Her pre-induction heart rate was 70 beats/min, and blood pressure was 120/70 mmHg. Anesthesia was induced with propofol 2 mg/kg, lidocaine 1.5 mg/kg, and rocuro- nium 0.3 mg/kg to produce neuromuscular blockade. The laryngeal mask was inserted successfully at the first attempt. General anesthesia was maintained with total intravenous anesthesia (TIVA) composed of propofol 6 mg/kg/h and remifentanil 0.2 lg/kg/min. Just after the dilatation of the cervix uteri, the patient’s ventricle abruptly began to flutter. Surgery and TIVA were imme- diately stopped. The anesthesia equipment was checked, as well as the monitoring and IV line, 100 % oxygen was administered, and the defibrillator was prepared for use. After 45–60 s, the ventricular flutter spontaneously resolved. Normal sinus rhythm resumed with a heart rate of 42 beats/min, and blood pressure was 100/50 mm Hg. Atropine 0.5 mg was administered, IV fluid administration was increased, and TIVA was restarted. After 10 min, heart rate increased to 60 beats/min and blood pressure to 122/68 mmHg. Depth of anesthetic was assured by the patient’s myotic pupils and absence of hypertension or sweating while propofol 8 mg/kg/h and remifentanil 0.25 lg/kg/min were infusing. Directly after introduction of the hysteroscopy device, another ventricular flutter occurred, so the hysteroscopy device was immediately removed from the uterine cavity. The oxygen level was elevated, and TIVA was stopped. After 10 s, her heart rate returned to an absolutely normal G. Basaranoglu (&) Á M. Bakan Á T. Umutoglu Á U. Topuz Á Z. Salihoglu Faculty of Medicine, Department of Anesthesiology and Reanimation, Bezmialem Vakif University, Vatan Caddesi, Fatih, 34093 Istanbul, Turkey e-mail: gbasaranoglu@hotmail.com M. Bakan e-mail: mefkur@yahoo.com T. Umutoglu e-mail: umutson77@hotmail.com U. Topuz e-mail: ufuktopuz@hotmail.com Z. Salihoglu e-mail: zsalihoglu@yahoo.com 123 Neurol Sci DOI 10.1007/s10072-014-2004-1