Efectos electrofisiológicos del sevoflurano versus propofol en niños con síndrome de Wolff-Parkinson-White

Pérez, E Rodríguez; Carretero, P. Sanabria; Fernández, C.; Mateos, Eduardo; Tarlovsky, L. Goldman

doi:10.1016/s0034-9356(08)70494-8

Cited by 14 publications

(4 citation statements)

References 13 publications

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“…El sevoflurano prolonga el periodo refractario de las vías accesorias en pacientes pediátricos diagnosticados de Síndrome de Wolff-Parkinson-White que se sometían a ablaciones de las vías accesorias 4 , pero no hay descrito en la literatura actual la aparición de un episodio de taquicardia supraventricular mantenida con una relación causal tan directa como en el caso que presentamos.…”

Section: Discussionunclassified

“…Entre las posibilidades diagnósticas que valoramos tras este episodio estarían la taquicardia por reentrada intranodal o la existencia de una vía accesoria 4 . Ante la inusual presencia de esta arritmia supraventicular en relación con la administración de sevofluorano, cuyo mecanismo exacto desconocemos, es preciso realizar un estudio electrofisiológico detallado a nuestro paciente en busca de una vía de conducción accesoria o una vía de reentrada intranodal que pudieran explicar este episodio.…”

Section: Discussionunclassified

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Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

Baines

Sánchez

Diego

et al. 2022

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Resumen La inducción anestésica inhalatoria con sevoflurano es muy empleada en la población pediátrica. Si bien los efectos sistémicos más comunes son ampliamente conocidos, no se conocen todos los efectos secundarios de este fármaco. Presentamos el caso clínico de un varón de cuatro años que desarrolló un episodio de taquicardia supraventricular sostenida tras la inducción anestésica con sevoflurano, que no cedió hasta que no se retiró el fármaco y se sustituyó el mantenimiento anestésico por una perfusión continua de fármacos hipnóticos intravenosos (propofol y remifentanilo). Desconocemos el mecanismo exacto por el que este episodio ha tenido una relación causal tan clara con la administración de sevoflurano; las posibilidades diagnósticas serían la taquicardia por reentrada intranodal o la existencia de una vía accesoria. No hemos encontrado en la literatura un episodio de taquicardia supraventricular mantenida con una relación causal directa con la administración de sevoflurano como en el caso que presentamos.

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Section: Discussionunclassified

Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

Baines

Sánchez

Diego

et al. 2022

An Sist Sanit Navar

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“…In adults, it did not affect the function of SA node or AV and AP conduction, and did not prevent diagnostic reciprocating tachycardias [32]. Also in children, when given after propofol, sevoflurane caused only moderate prolongation of the AP antegrade effective refractory period, without interfering with the ablative procedure [33]. On the other hand, desflurane at 1 MAC prolonged the AP effective refractory period and impaired the induction of diagnostic SVTs in paediatric patients [24].…”

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 95%

“…Conversely, experimental studies have shown that sevoflurane exerts only moderate effects on cardiac electrophysiology [21]. Additionally, clinical data suggest that sevoflurane has a favorable profile for use in EPS/ablations [32,33]. In adults, it did not affect the function of SA node or AV and AP conduction, and did not prevent diagnostic reciprocating tachycardias [32].…”

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

erioperative management of patients with pre-excitation syndromes

2018

Rom J Anaesth Int Care

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Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil , alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other preexcitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.

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Drug-Induced Loss of Preexcitation in Pediatric Patients with WPW Pattern During Electrophysiologic Study

et al. 2018

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Ablation of accessory pathways (AP) is one of the most often performed procedures in pediatric electrophysiology. In pediatric patients these procedures are mostly performed in anaesthesia or sedation. In some of these patients who are referred for electrophysiologic (EP) study, we could observe disappearance of the preexcitation, i.e. antegrade conduction of an AP during introduction of sedation. As a suppression of AP conduction capacities has been reported as negative side effect of propofol and other anaesthetics, the aim of this study was to evaluate risk factors for drug-induced suppression of AP conduction properties. Consecutive, pediatric patients with Wolff-Parkinson-White (WPW) pattern referred for EP study in the period of 2016-2017 were reviewed in retrospect. Patients with complex congenital heart disease were excluded. An entire chart review including ECG, bicycle stress testing, and periprocedural data was performed. In 4 of 37 patients included into the study, loss of preexcitation could be observed during sedation. Data analysis showed weaker conduction capacities of the AP as a risk factor (p = 0.009). Interestingly, absolute (p = 0.11) or adjusted to body weight (p = 0.92) drug doses were not a relevant risk factor. Patients with WPW and weaker conduction capacities of the AP, as implied by an early disappearance of preexcitation during exercise stress testing, seem to be more prone to drug-induced suppression of an AP.

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Efectos electrofisiológicos del sevoflurano versus propofol en niños con síndrome de Wolff-Parkinson-White

Cited by 14 publications

References 13 publications

Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

erioperative management of patients with pre-excitation syndromes

Drug-Induced Loss of Preexcitation in Pediatric Patients with WPW Pattern During Electrophysiologic Study

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