A Novel Anaesthetical Approach to Patients with Brugada Syndrome in Neurosurgery

Abstract

Brugada syndrome (BrS) is one of the most common causes of sudden death in young people. It usually presents with life-threatening arrhythmias in subjects without remarkable medical history. The need for surgical treatment may unmask BrS in otherwise asymptomatic patients. The best anaesthesiological treatment in such cases is matter of debate. We report a case of neurosurgical treatment of cerebello pontine angle (CPA) tumor in a BrS patient, performed under total intravenous anesthesia (TIVA) with target controlled infusion (TCI) modalities, using midazolam plus remifentanil and rocuronium, without recordings of intraoperative ECG alterations in the intraoperative period and postoperative complications.

A Case Report on Brugada Syndrome and Anesthesia Considerations

“…Propofol, the commonly used hypnotic agent has the potential to alter ion channel function inducing Brugada-like ECG abnormalities, which can exacerbate the risk of malignant arrhythmias in BrS patients [1,3]. While the literature review supports the avoidance of propofol on induction and maintenance, no ST changes were noted on induction with its use on this patient.…”

“…Rest of the systems were found to be within normal limits. The 12 lead ECG performed on this patient showed a partial right bundle branch block (RBBB) with a concave pattern of ST elevation in leads V1 to V3 consistent with the BrS pattern [1,2]. Echocardiogram showed no structural or valvular heart disease ( Figure 1).…”

“…A naturally occurring mutation in the IQ domain alters hH1 function in a manner characteristic of BrS [2]. Although BrS is rare, it is considered the most prevalent cause of sudden cardiac death in younger population [1,2]. BrS raises specific …”

“…History of previous surgeries done uneventfully under general anesthesia do not lower the risks of subsequent adverse events in future [1]. This patient had a brain tumor removed two years ago without any major complications.…”

“…concerns because anesthesia providers routinely administer drugs that interact with cardiac ion channels, potentially triggering the development of malignant arrhythmias [1][2][3][4]. History of previous surgeries done uneventfully under general anesthesia do not lower the risks of subsequent adverse events in future [1].…”