Anaesthesia in patients with Brugada syndrome

Abstract

Brugada syndrome is characterized by right bundle branch block, ST segment elevation in the precordial leads and sudden death caused by ventricular fibrillation. We present two successful anaesthetic management cases in patients with Brugada syndrome. Accepted for publication 8 May 2004Key words: Brugada syndrome; complications; electrocardiography; sudden death.# Acta Anaesthesiologica Scandinavica 48 (2004) I N 1992 a new syndrome was described consisting of syncope or sudden death in patients with a structurally normal heart and an electrocardiogram (ECG) characteristic of right bundle branch block with ST segment elevation in leads V 1 to V 3 . This condition was named 'Brugada syndrome' (1). The syndrome is genetically determined and caused by mutations in the gene SCN5A on chromosome 3, encoding the human cardiac sodium channel (2).There are few reports of anaesthetic management of patients with Brugada syndrome, and especially regional anaesthesia of patients with Brugada syndrome. Therefore, we report one case of regional anaesthesia and one case of general anaesthesia in patients with Brugada syndrome. Case report Case 1A 33-year-old man was presented for an emergency orthopaedic operation due to open fracture of the patella. One year ago, before admission, Brugada syndrome was diagnosed in routine cardiologic evaluation. He had no past history of syncope and there was no family history of sudden death. On admission, a physical examination revealed no abnormal findings except ECG findings showing the coved-type ST segment elevation in leads V 1 to V 3 with a right bundle branch block (Fig. 1). Echocardiography showed a normal heart with an ejection fraction of 60%. Electrophysiology study revealed normal sinus node function, but non-sustained ventricular tachycardia was induced by electric ventricular stimulation.Having been informed of the associated risks, the patient was taken to the operating room and routine monitors were applied. A radial arterial cannula was inserted under local anaesthetic. Prior to the induction of anaesthesia, an external defibrillator was prepared. Spinal tapping was carried out at the L4/5 space in right lateral position. Afterwards, 0.5% bupivacaine hydrochloride 10 mg was injected intrathecally and satisfactory spinal block was achieved up to the T 10 dermatome.During the operation, ECG and continuous blood pressure were monitored and showed no abnormalities.After a 2-h operation, the patient was transferred to the post anaesthetic care unit (PACU) and postoperative pain was controlled with intravenous patientcontrolled analgesia (PCA) using opioids and NSAID. Postoperative recovery was uneventful. Case 2A 56-year-old male with L 1 vertebral body compression fracture scheduled for spine fusion under general anaesthesia. His preoperative 12-lead ECG showed a complete right bundle branch block and ST segment elevation (Fig. 2). There was no family history of sudden death. Several years ago, before admission, he had one history of syncope attack. Echocardiogram showed no s...

Brugada syndrome and anesthesia

“…Our research also indicated that the inhalation anesthetics isoflurane, [27,45,46] desflurane, [27,34] sevoflur ane, [27][28][29][31][32][33]35,41,43,[47][48][49] and N 2 O [27,29,31,43,45,48] were safely Horigome et al [42] 13/M Fuyuta et al [32] 72/M Phillips et al [33] 77/M [34] anterior chest wall wound induction (propofol 140 mg, vecuronium 8 mg), maintenance (desflurane, vecuronium 20 mg, fentanyl)…”

“…[42] The opioids fentanyl, [28,[31][32][33][34][35]37,38,[41][42][43][45][46][47][48]50] sufentanil, [40] morphine, [42] and remifentanil [28,32] were frequently prescribed as adjuvants to general anesthesia. Two patients were also given opioids via an epidural.…”

“…[51] All opioids except high-dose morphine, caused reversible suppression of sodium channels, but as long the patients took the prescribed dosage, they were safe. [52] Local anesthetics like bupivacaine, [33,40,45,46,50,53] lidocaine, [27,29,32] and ropivacaine [35] are also prescribed for BS patients. Of these, lidocaine is generally given in low doses and is safe when used as an adjuvant in induction.…”

“…Our patients also received the NMBAs vecuronium, [27,29,34,35,43,45,46,54] rocuronium, [30][31][32][33]36] cisatracurium, [28,47] succinylcholine, [27,38,45] and atracurium [37,38,48] but succinylcholine is not normally used because of its adverse effects. [29] As an anticholinesterase agent, neostigmine is also avoided because it can lead to ST-segment elevation in BS patients.…”

Sugammadex in a Patient with Brugada Syndrome

“…Bu olguda hemodinamik istikrarı daha iyi sağlayabileceğimizi düşündüğümüz genel anestezi uygulamasını tercih ettik. Genel anestezi indüksiyonunda, bu olguda olduğu gibi tiyopentalin Brugada Sendromlu hastalarda sorunsuz kullanıldığını gösteren olgular bulunmaktadır (9)(10)(11). Propofolün yüksek dozlarda infüzyonu, özellikle yoğun bakım ünitelerinde sedasyon amacıyla 4 mg kg -1 h -1 üzerin-deki dozlarda EKG'de BS benzeri şekil oluşturduğu belirtilmiştir (12).…”