Sudden Cardiac Arrest During General Anesthesia in an Undiagnosed Brugada Patient

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)…”

“…were employed in the BS cases in this study. The intravenous anesthetic propofol was used for both the induction [27][28][29][30][31][32][33][34][35][36][37][38] and maintenance of anesthesia [29,[37][38][39][40] while midazolam was utilized for both premedication [31,34,37,38,41] and induction. [27,29,33] Only the one case in which ketamine and diazepam were used died, [42] and this was due to sedation with high-dose ketamine, which led to cardiac arrest.…”

“…[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.…”