Anaesthetic management of Wolff-Parkinson-White syndrome for hysterectomy

Abstract

Wolff–Parkinson–White syndrome (WPW) is an uncommon cardiac disorder having an aberrant pathway between atria and ventricles. We are reporting a known case of WPW syndrome for hysterectomy under combined spinal epidural anaesthesia. Management of the present case is an important pearl to revisit management of WPW syndrome. The perioperative management should be tailored according to the nature of surgery and the clinical presentation of the patient.

Anaesthetic Management of Patient With Mitral Valve Prolapse and Wolf Parkinson White Syndrome for Urological Procedure

“…Central neuraxial blocks have been found to be advantageous and have been successfully used to manage various lower abdominal and perineal surgeries. [7,8,9] The chances of arrhythmias are increased in general anaesthesia because of pain and lighter plane of anaesthesia.…”

Sugammadex Use in a Patient with Wolff-Parkinson-White (WPW) Syndrome

“…Life-threatening arrhythmias such as paroxysmal SVT or VT have been reported to occur in WPW syndrome in the literature. The incidence of WPW in the general population is between 0.1% and 3% (1)(2)(3)(4)(5).…”

“…Mivacurium may be safe because reversal with neostigmine and glycopyrrolate are not necessary. However, mivacurium causes the release of histamine and tachycardia (1,5). Sugammadex is a newly developed drug and it used to reverse rocuronium-or vecuronium-induced neuromuscular blockade.…”

Wolff-Parkinson-White pattern unmasked by severe musculoskeletal pain

“…The WPW pattern can be unmasked under different scenarios, including anesthesia, sympathomimetic drugs, and postoperatively. [3][4][5] Catecholamine challenge has been used to unmask high-risk features in WPW syndrome. 3 Our patient may have had a transient spike in catecholamine levels because of severe musculoskeletal pain, leading to unmasking of accessory pathways and resulting in the WPW pattern on electrocardiography.…”