Spinal anesthesia for Cesarean section in a parturient with long QT syndrome

Al-Refai, Abdulrahman; Gunka, V.; Douglas, Joanne

doi:10.1007/bf03018486

Cited by 30 publications

(17 citation statements)

References 14 publications

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“…The effect of a magnet on the ICD should also be noted, whether the magnet will deactivate the defibrillator function, and whether the ICD program will be altered once the magnet is removed. 19,20 An ECG can be used to assess the frequency of paced beats. 2 Beta blockers are the mainstay of drug therapy in patients with LQTS with the exception of LQT3.…”

Section: 12mentioning

confidence: 99%

“…2,15 Beta blockers should be continued throughout pregnancy and the peripartum period. 9,20,22,23,[26][27][28][29][30] Any drugs that prolong the QT interval (Table II) should be withdrawn or reduced. 2 Obstetric medications known to prolong the QT interval include terbutaline and ritrodine which are used to arrest preterm labour.…”

Section: Peripartummentioning

confidence: 99%

“…Regional analgesia/anesthesia is advantageous for LQTS parturients as reduction of the stress response and provision of effective analgesia moderates catecholamine release, reducing the risk of torsades. 20 An epidural block also decreases the need for pushing and facilitates operative delivery. The disadvantage of regional anesthesia in LQTS is the potential for a high block, causing hypotension and bradycardia-induced parasympathetic override.…”

Section: Analgesia and Anesthesia For Labour And Deliverymentioning

confidence: 99%

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Brief review: Anesthetic implications of long QT syndrome in pregnancy

Drake

Preston

Douglas

2007

Can J Anesth/J Can Anesth

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Purpose:To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. Principal findings:The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.Conclusion: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.

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Section: 12mentioning

confidence: 99%

Section: Peripartummentioning

confidence: 99%

Section: Analgesia and Anesthesia For Labour And Deliverymentioning

confidence: 99%

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Brief review: Anesthetic implications of long QT syndrome in pregnancy

Drake

Preston

Douglas

2007

Can J Anesth/J Can Anesth

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“…Se ha visto que la anestesia espinal también prolonga el QTc 92 , aunque el bloqueo adrenérgico y la analgesia que provee son deseables. Existen reportes de su uso exitoso en pacientes con LQTS en el campo de la obstetricia [93][94][95][96] . Algunos autores reportan la anestesia epidural como alternativa más segura, aludiendo al hecho de una instauración más gradual, con menor hipotensión, y por tanto, menos probabilidad de uso de drogas simpaticomiméticas 97 .…”

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“…Algunos autores reportan la anestesia epidural como alternativa más segura, aludiendo al hecho de una instauración más gradual, con menor hipotensión, y por tanto, menos probabilidad de uso de drogas simpaticomiméticas 97 . Existe poca evidencia disponible sobre el efecto de los anestésicos locales en el LQTS, aunque se ha reportado el uso de lidocaína, bupivacaína y levobupivacaína neuroaxial sin presentar inconvenientes 93,95,98,99 . En general, hay consenso en no utilizar epinefrina como complemento a la dosis neuroaxial.…”

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El síndrome de QT largo en anestesia. Una revisión a partir de un caso clínico

2015

Rev Chil Anest

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Das Long-QT-Syndrom in der Anästhesie

2006

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The long QT syndrome (LQTS) is a rare, congenital or acquired disease, which may lead to fatal cardiac arrhythmias (torsade de pointes, TdP). In all LQTS subtypes, TdPs are caused by disturbances in cardiac ion channels. Diagnosis is made using clinical, anamnestic and electrocardiographic data. Triggers of TdPs are numerous and should be avoided perioperatively. Sufficient sedation and preoperative correction of electrolyte imbalances are essential. Volatile anaesthetics and antagonists of muscle relaxants should be avoided and high doses of local anaesthetics are not recommended to date. Propofol is safe for anaesthesia induction and maintenance. The acute therapy of TdPs with cardiovascular depression should be performed in accordance with the guidelines for advanced cardiac life support and includes cardioversion/defibrillation and magnesium. Torsades de pointes may be associated with bradycardia or tachycardia resulting in specific therapeutic and prophylactic measures.

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Spinal anesthesia for Cesarean section in a parturient with long QT syndrome

Abstract: Spinal anesthesia was used safely for CS in this parturient with LQTS.

Cited by 30 publications

References 14 publications

Brief review: Anesthetic implications of long QT syndrome in pregnancy

Brief review: Anesthetic implications of long QT syndrome in pregnancy

El síndrome de QT largo en anestesia. Una revisión a partir de un caso clínico

Das Long-QT-Syndrom in der Anästhesie

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