Propofol for Induction and Maintenance of Anesthesia in Patients With Brugada Syndrome: A Single-Center, 25-Year, Retrospective Cohort Analysis

Flamée, Panagiotis; Viaene, Kea; Tosi, Maurizio; Carvalho, Hugo; Asmundis, Carlo de; Forget, Patrice; Poelaert, Jan

doi:10.1213/ane.0000000000005540

Cited by 5 publications

(6 citation statements)

References 36 publications

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“…All studies were published in medical journals and were in English. These included twenty-nine case reports , nine case series (46)(47)(48)(49)(50)(51)(52)(53)(54), eleven clinical trials out of which four were randomized (55-58) and seven were non-randomized (59)(60)(61)(62)(63)(64)(65). The process of study selection has been summarized in Figure 3.…”

Section: Resultsmentioning

confidence: 99%

Brugada Syndrome and Anesthesia: A Systematic Review

Suchal

Afzal

Karim

2022

Preprint

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Brugada Syndrome is an inherited disorder causing specific changes on electrocardiogram (ECG) pattern of right bundle branch block and persistent ST elevation in right precordial leads increases the risk of cardiac arrest and fatal arrhythmia. Patients with brugada are prone to abnormal cardiac rhythms which can be induced by alcohol, stress, vagal stimulation, and certain medications. Thus medications are divided into different classes from I to III with I carrying the most evidence for potential arrhythmia while III being the least likely. Exceptional care needs to be taken to avoid anesthetic and analgesic during surgeries for such patients as several of the known anesthesia medications can lead to arrhythmia in these patients. In this review we aimed to study the effect different anesthetic and analgesic medication could have on patients with brugada syndrome. We conducted a systematic review following PRISMA guidelines to query PubMed, Embase, Cochrane library and ProQuest electronic databases. Mesh combinations and synonyms of “Brugada Syndrome”, “Anesthesia”, “Analgesics” were used. We included all original human studies that focused on outcomes of anesthetic and analgesics on patients with brugada. After screening 1149 studies, we included 49 articles consisting of a total of 1414 subjects for qualitative analysis. We found local analgesics to be least likely to lead to potential arrhythmic complications with other systemic and inhaled agents having a risk although the risk varied because of multitude of reasons ranging from type of drug to patient factors like the patient’s condition and type of Brugada. We concluded that anesthetic although could be used for individuals with Brugada the type of anesthetic to be used should be selected keeping the potential cardiac risk under consideration.

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Section: Resultsmentioning

confidence: 99%

Brugada Syndrome and Anesthesia: A Systematic Review

Suchal

Afzal

Karim

2022

Preprint

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“…While propofol is one of the most widely used intravenous anesthetics, there has been extensive debate regarding the safety of propofol bolus or continuous infusion in patients with Brugada syndrome because of its arrhythmogenic effects [ 6 ]. Recently, Flamée et al reported its safe use without critical arrhythmias in the operating theater or the intensive care unit [ 7 ]. In addition, they also reported that induction with propofol or etomidate did not affect ST-segment elevation [ 9 ] whereas Ciconte et al showed that propofol significantly reduced ST-segment elevation immediately after induction [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our plan can realize induction 6) At eye-opening upon emergence from anesthesia. (7) Immediately before transfer to the high care unit. B Changes in the value of ST-segment (J-point) amplitudes in lead V2 in the operating room.…”

Section: Discussionmentioning

confidence: 99%

“…Sevoflurane and propofol are widely used general anesthetics in current anesthetic practice, but their use with caution in patients with Brugada syndrome is still recommended [6]. On the other hand, some studies revealed that induction with propofol bolus and volatile-based anesthesia caused reduction or no exacerbation of STsegment elevation without VT/VF [7][8][9]. Although there may exist safe methods of anesthetic management in patients with Brugada syndrome that attenuate ST-segment elevation, to our knowledge there are no reports of ST-segment morphology throughout general anesthesia for major surgery in such patients.…”

Section: Introductionmentioning

confidence: 99%

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Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report

Saito,

Yoshida,

Hirota

2024

JA Clin Rep

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Background During general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established. Case presentation A 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia. Conclusion The present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.

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“…On the contrary, recent research could not provide evidence of the alleged arrhythmogenicity of propofol in such patients. 4 , 5 Currently, a prospective study for investigating those effects is ongoing (EudraCT Register: 2019-004750-28)…”

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confidence: 99%