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Abstract A critically ill patient is one at imminent risk of death; the severity of illness must be recognized early and appropriate measures taken promptly to assess, diagnose and manage the illness Critically ill patients present to the anesthetist from three main areas within the hospital. The Emergency Department,The general hospital, The Intensive Care Unit. These patients face three main problem Traumatic injuries, hemorrhagic shock, Hypothermia, Severe sepsis which causes variant types of arrhythmias. Pathophysiology of arrhythmias mainly occurs between the atria and ventricles as reentry, accessory conduction pathways (”bypass tracts”) such as the bundle of Kent, suppressed automaticity, enhanced automaticity Preoperative arrhythmias predicted from pre- operative assessment of critically ill patients by acute physiology and chronic health evaluation score, Simplified acute physiology score, Mortality prediction model, Sepsis-related organ failure assessment, multiple organ dysfunction score, Sepsis score, The Revised Trauma Score (TS) Preoperative arrhythmias occurs due to many reasons as electrolyte imbalances, co-morbidity, hormone mediators or direct physical stimulation either by the surgeon or anesthetist can precipitate dysrhythmias, hypoxia and drugs Preoperative arrhythmias are atrial as, Sinus arrhythmia( Atrial ectopic, Atrial ectopic,) Sinus tachycardia, Supraventricular tachycardias, Paroxysmal supraventricular tachycardia (PSVT),Atrial fibrillation (AF), Sick sinus syndrome, Wolff-Parkinson-White syndrome and Ventricular arrhythmias Non-sustained ventricular arrhythmias ventricular arrhythmias, Sustained VT(monomorphic and polymorphic in monomorphic VT) Intra operative arrhythmias, emerging from the time of entry the operative room for surgery to the time of discharge, are still an unresolved, potentially preventable clinical problem.it caused by Physiological, Electrolyte disturbance, malignant hyperthermia, Special surgeries, Cardiac disease, Drugs. Intraoperative atrial arrhythmias are atrial arrhythmias such as paroxysmal or multifocal atrial to atrial fibrillation and flutter and ventricular arrhythmias are sustained VT or fibrillation, cardiac arrest and bigeminy and heart block which treated by Rate control, Rhythm Control, Surgical therapy.Post-operative arrhythmias are common problem which may be simple tachycardia paroxysmal supraventricular tachycardia paroxysmal or multifocal atrial tachycardias, Atrial fibrillation, Malignant ventricular arrhythmias (fibrillation or tachycardia) these types should be predicted and treated to improve outcome of surgeries. |