Long QT syndrome incidence is increasing in general population. A careful pre-, peri- and post-operative management is needed for patients with this syndrome because of the risk of Torsades de Pointes and malignant arrhythmias. The available data regarding prevention of lethal Torsades de Pointes during anesthesia in patients with long QT syndrome is scant and conflicting: only case reports and small case series with different outcomes have been published. Actually, there are no definitive guidelines on pre-, peri- and post-operative anesthetic management of congenital long QT syndrome. Our review focuses on anesthetic recommendations for patients diagnosed with congenital long QT syndrome furnishing some key points for preoperative optimization, intraoperative anesthetic agents and postoperative care plan, which could be the best for patients with c-long QT syndrome who undergo surgery.
In the present paper an attempt is made to find out whether the pharmacological arousal elicited by anti-ChE drugs can be attributed to differential inactivation of either the true ChE or the pseudo-ChE of the brain. For this purpose, a number of compounds inhibiting selectively either type of ChE were administered by arterial injection to the brains of cats, and a threshold dose producing a clear-cut arousal effect was defined in each case.When using such pharmacological tools, a number of precautions are essential because the selectivity of these compounds is only relative: indeed it may vary by a factor of 100 from one mammalian species to another
Beta-blocking therapy is the cornerstone of LQTS therapy but actually there is no clear indication about which beta-blocker should be used. In our experience bisoprolol proved to be less harmful and easier to manage than propranolol and nadolol in patients with LQTS, with the same effectiveness in preventing major cardiovascular events.
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