1
|
Meng L, Rasmussen M, Abcejo AS, Meng DM, Tong C, Liu H. Causes of Perioperative Cardiac Arrest: Mnemonic, Classification, Monitoring, and Actions. Anesth Analg 2024; 138:1215-1232. [PMID: 37788395 DOI: 10.1213/ane.0000000000006664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Perioperative cardiac arrest (POCA) is a catastrophic complication that requires immediate recognition and correction of the underlying cause to improve patient outcomes. While the hypoxia, hypovolemia, hydrogen ions (acidosis), hypo-/hyperkalemia, and hypothermia (Hs) and toxins, tamponade (cardiac), tension pneumothorax, thrombosis (pulmonary), and thrombosis (coronary) (Ts) mnemonic is a valuable tool for rapid differential diagnosis, it does not cover all possible causes leading to POCA. To address this limitation, we propose using the preload-contractility-afterload-rate and rhythm (PCARR) construct to categorize POCA, which is comprehensive, systemic, and physiologically logical. We provide evidence for each component in the PCARR construct and emphasize that it complements the Hs and Ts mnemonic rather than replacing it. Furthermore, we discuss the significance of utilizing monitored variables such as electrocardiography, pulse oxygen saturation, end-tidal carbon dioxide, and blood pressure to identify clues to the underlying cause of POCA. To aid in investigating POCA causes, we suggest the Anesthetic care, Surgery, Echocardiography, Relevant Check and History (A-SERCH) list of actions. We recommend combining the Hs and Ts mnemonic, the PCARR construct, monitoring, and the A-SERCH list of actions in a rational manner to investigate POCA causes. These proposals require real-world testing to assess their feasibility.
Collapse
Affiliation(s)
- Lingzhong Meng
- From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mads Rasmussen
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Arnoley S Abcejo
- Department of Anesthesiology, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Deyi M Meng
- Choate Rosemary Hall School, Wallingford, Connecticut
| | - Chuanyao Tong
- Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California
| |
Collapse
|
2
|
Saito K, Yoshida H, Hirota K. Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report. JA Clin Rep 2024; 10:18. [PMID: 38467908 PMCID: PMC10928048 DOI: 10.1186/s40981-024-00702-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND During general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established. CASE PRESENTATION A 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia. CONCLUSION The present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.
Collapse
Affiliation(s)
- Kurumi Saito
- Department of Anesthesiology, Hirosaki General Medical Center, 1 Tomino-Cho, Hirosaki, 036-8174, Japan.
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, 036-8562, Japan.
| | - Hitoshi Yoshida
- Department of Anesthesiology, Hirosaki General Medical Center, 1 Tomino-Cho, Hirosaki, 036-8174, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, 036-8562, Japan
| |
Collapse
|
3
|
Kiefer NJ, Ahuja T, Caballero A, Pashun RA. To cool or not to cool: Targeted temperature management to prevent ventricular tachycardia associated with Brugada syndrome. Clin Case Rep 2023; 11:e8338. [PMID: 38130853 PMCID: PMC10733563 DOI: 10.1002/ccr3.8338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/02/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Key Clinical Message A robust inflammatory and febrile response from acute viral illness such as with SARS-CoV-2 in patients with Brugada syndrome may lead to triggering of ventricular arrhythmias. The use of targeted temperature management (TTM) using cooling devices may mitigate the febrile triggering of ventricular arrhythmias in patients with Brugada syndrome. Abstract Brugada syndrome (BrS) is an autosomonal dominant genetic disorder, with a risk of ventricular tachycardia (VT). Triggers of VT in BrS include fevers. Here, we report a case of BrS secondary to SARSs-CoV-2 infection and the use of targeted temperature management (TTM) to decrease fever and prevent VT triggering.
Collapse
Affiliation(s)
- Nicholas J. Kiefer
- Department of Medicine, The Leon H. Charney Division of CardiologyNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Tania Ahuja
- Department of Medicine, The Leon H. Charney Division of CardiologyNew York University Grossman School of MedicineNew YorkNew YorkUSA
- Department of PharmacyNew York University Langone HealthNew YorkNew YorkUSA
| | | | - Raymond Anthony Pashun
- Department of Medicine, The Leon H. Charney Division of CardiologyNew York University Grossman School of MedicineNew YorkNew YorkUSA
| |
Collapse
|
4
|
Dell’Olio F, Lorusso P, Siciliani RA, Massaro M, Barile G, Tempesta A, Grasso S, Favia G, Limongelli L. Type 1 citrullinemia patient with Brugada pattern undergoing general anesthesia for dental extractions: A case report. Clin Case Rep 2023; 11:e7657. [PMID: 37575462 PMCID: PMC10415584 DOI: 10.1002/ccr3.7657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 08/15/2023] Open
Abstract
Key Clinical Message The perioperative control of ammonia, reduction of stress, and administration of drugs tolerated in type 1 citrullinemia and Brugada pattern allowed the successful and uneventful management of general anesthesia in the study patient. Abstract The aim of this study was to report the targeted perioperative management of general anesthesia (GA) adopted for dental extractions in a rare patient with type 1 citrullinemia and Brugada pattern. A male, Caucasian, adult type 1 citrullinemia patient needed dental extractions under GA. The medical history showed neurodevelopmental impairment, growth retardation, epilepsy, and a Type 2 Brugada electrocardiographic pattern in the second precordial lead. The authors focused the anesthesiologic protocol on the prevention of hyperammonemia and fatal arrhythmias. Changes in diet and 10% glucose solution administration prevented protein catabolism due to the fasting period (ammonia was 44 μmol/L preoperatively and 46 μmol/L postoperatively; glycemia was 120 g/dL preoperatively and 153 g/dL postoperatively). The patient received a continuous electrocardiogram, noninvasive blood pressure, pulse oximeter, entropy monitoring, train-of-four monitoring, and external biphasic defibrillator pads. Midazolam, remifentanil, and dexamethasone were administered for pre-anesthesia; thiopental and rocuronium for induction; remifentanil and desflurane for maintenance; sugammadex for decurarization. After the intraligamentary injection of lidocaine 2% with epinephrine 1:100,000 for local anesthesia, the patient developed a transient Type 1 Brugada pattern that lasted a few minutes. The whole procedure lasted 30 min. The patient's discharge to ward occurred 3 h after the end of GA. The perioperative management of ammonia, reduction of stress, and administration of drugs tolerated in Type 1 citrullinemia and Brugada pattern allowed the successful and uneventful administration of GA in the study patient.
Collapse
Affiliation(s)
- Fabio Dell’Olio
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| | - Pantaleo Lorusso
- Department of Emergency and Organ Transplantation, Operating Unit of AnesthesiologyAldo Moro UniversityBariItaly
| | - Rosaria Arianna Siciliani
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| | - Maria Massaro
- Department of Emergency and Organ Transplantation, Operating Unit of AnesthesiologyAldo Moro UniversityBariItaly
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| | - Angela Tempesta
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| | - Salvatore Grasso
- Department of Emergency and Organ Transplantation, Operating Unit of AnesthesiologyAldo Moro UniversityBariItaly
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine, Complex Operating Unit of OdontostomatologyAldo Moro UniversityBariItaly
| |
Collapse
|
5
|
Hsu CH, Lin SH, Chang LY. Anesthesia in patients with Brugada syndrome: two case reports. J Med Case Rep 2023; 17:275. [PMID: 37322558 DOI: 10.1186/s13256-023-03934-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/17/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Brugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention. CASE PRESENTATION We report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful. CONCLUSIONS Brugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.
Collapse
Affiliation(s)
- Che-Hao Hsu
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan.
| | - Shin-Hong Lin
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
| | - Li-Yen Chang
- Department of Anesthesiology, Tungs' Taichung MetroHarbor Hospital, Taichung, 43503, Taiwan
- Department of Anesthesiology, Taichung Armed Forces General Hospital, Taichung, 41169, Taiwan
| |
Collapse
|
6
|
Yu J, Nishi C, Adly E, Cordovani D. Rethinking spinal anesthetic with bupivacaine for cesarean delivery in parturient with Brugada syndrome. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:236-237. [PMID: 36096235 PMCID: PMC10068530 DOI: 10.1016/j.bjane.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Janice Yu
- McMaster University, Department of Anesthesia, Hamilton, Canada.
| | - Cameron Nishi
- McMaster University, Department of Anesthesia, Hamilton, Canada
| | - Elaheh Adly
- McMaster University, Department of Anesthesia, Hamilton, Canada
| | | |
Collapse
|
7
|
Ojaimi RE, Carteron M, Arnold S, Broux N, Corsia G, Zicarelli JP, Benhamou D. Neuraxial anesthesia for delivery in parturtients with Brugada syndrome: Local anesthetics revisited. J Gynecol Obstet Hum Reprod 2023; 52:102562. [PMID: 36858196 DOI: 10.1016/j.jogoh.2023.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Affiliation(s)
- R El Ojaimi
- AP-HP, Département d'Anesthésie Réanimation and Médecine Péri Opératoire, Hôpital Henri, Mondor, 94000 Créteil, France
| | - M Carteron
- Service d'Anesthésie Réanimation and Médecine Péri Opératoire, Centre Hospitalier Jacques, Coeur Bourges, France
| | - S Arnold
- Département d'Anesthésie Réanimation and Médecine Péri Opératoire, Centre Hospitalier, Sud-Francilien, Corbeil-Essonnnes, France
| | - N Broux
- Service d'Anesthésie, Centre Hospitalier de Niort, France
| | - G Corsia
- AP-HP, Département d'Anesthésie Réanimation and Médecine Péri Opératoire, Hôpital La Pitié-Salpétrière, Paris, France
| | - J P Zicarelli
- AP-HM, Département d'Anesthésie Réanimation and Médecine Péri Opératoire, France
| | - D Benhamou
- AP-HP Département d'Anesthésie, Réanimation and Médecine Péri Opératoire, Université Paris-Saclay, Hôpital Universitaire Bicêtre, 94275 Le Kremlin-Bicêtre, France.
| |
Collapse
|
8
|
Alvarez CK, Zweibel S, Stangle A, Panza G, May T, Marieb M. Anesthetic Considerations in the Electrophysiology Laboratory: A Comprehensive Review. J Cardiothorac Vasc Anesth 2023; 37:96-111. [PMID: 36357307 DOI: 10.1053/j.jvca.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Catheter ablation procedures for arrhythmias or implantation and/or extraction of cardiac pacemakers can present many clinical challenges. It is imperative that there is clear communication and understanding between the anesthesiologist and electrophysiologist during the perioperative period regarding the mode of ventilation, hemodynamic considerations, and various procedural complications. This article provides a comprehensive narrative review of the anesthetic techniques and considerations for catheter ablation procedures, ventilatory modes using techniques such as high-frequency jet ventilation, and strategies such as esophageal deviation and luminal temperature monitoring to decrease the risk of esophageal injury during catheter ablation. Various hemodynamic considerations, such as the intraprocedural triaging of cardiac tamponade and fluid administration during catheter ablation, also are discussed. Finally, this review briefly highlights the early research findings on pulse-field ablation, a new and evolving ablation modality.
Collapse
Affiliation(s)
- Chikezie K Alvarez
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT.
| | - Steven Zweibel
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Alexander Stangle
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Gregory Panza
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; University of Connecticut, Farmington, CT
| | - Thomas May
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT
| | - Mark Marieb
- Hartford HealthCare Heart and Vascular Institute, Hartford, CT; Griffin Hospital, Derby, CT
| |
Collapse
|
9
|
Labor Analgesia in Brugada Syndrome and the Importance of Contingency Planning. Case Rep Anesthesiol 2022; 2022:8940704. [PMID: 35874793 PMCID: PMC9307403 DOI: 10.1155/2022/8940704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome is an autosomal dominant disorder that affects cardiac sodium channels and predisposes patients to an increased risk of sudden cardiac death. Obstetric anesthesia management in patients with Brugada syndrome poses a challenge due to the prevalence of local anesthetic use for labor analgesia or cesarean section. However, central neuraxial techniques and local anesthetics have been used safely in parturients with this syndrome and may be offered to patients during preadmission counseling. We present the case of a primigravida who opted for further labor analgesia via a combined spinal-epidural technique. To our knowledge, this is the first case report of a lidocaine infusion administered via an epidural catheter to a laboring parturient with Brugada syndrome. We further discuss the use of local anesthetics, other medications, and central neuraxial techniques in those with Brugada syndrome to assist anesthesiologists caring for expectant mothers.
Collapse
|
10
|
Zimmermann P, Aberer F, Braun M, Sourij H, Moser O. The Arrhythmogenic Face of COVID-19: Brugada ECG Pattern in SARS-CoV-2 Infection. J Cardiovasc Dev Dis 2022; 9:jcdd9040096. [PMID: 35448072 PMCID: PMC9027624 DOI: 10.3390/jcdd9040096] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/15/2022] Open
Abstract
In 1992, Brugada syndrome (BS) was first described; an often unrecognized cardiac conduction disorder mainly associated with unexplained sudden cardiac arrest and consecutive syncope. Nevertheless, the pathomechanism of BS and sudden cardiac death remains mainly explained. Mutations in the cardiac sodium channels, which cause a reduction or functional loss of these channels, are associated with characteristic electrocardiographic (ECG) abnormalities and malignant arrhythmia. The majority of affected people are previously healthy and unaware of their genetic predisposition for BS and might experience ventricular tachyarrhythmias and cardiac arrest potentially triggered by several factors (e.g., alcohol, sodium channel blockers, psychotropic drugs, and fever). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was firstly identified in Wuhan in early December 2019 and rapidly spread worldwide as coronavirus disease (COVID-19). COVID-19 is typically characterized by a severe inflammatory response, activation of the immune system, and high febrile illness. Due to this condition, symptomatic COVID-19 infection or vaccination might serve as inciting factor for unmasking the Brugada pattern and represents a risk factor for developing proarrhythmic complications. The aim of this narrative review was to detail the association between virus-related issues such as fever, electrolyte disturbance, and inflammatory stress of COVID-19 infection with transient Brugada-like symptoms and ECG-pattern and its susceptibility to proarrhythmogenic episodes.
Collapse
Affiliation(s)
- Paul Zimmermann
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Felix Aberer
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
- Correspondence: ; Tel.: +43-316-385-86113
| | - Martin Braun
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany;
| | - Harald Sourij
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| | - Othmar Moser
- Department of Sport Science, Division of Exercise Physiology and Metabolism, University of Bayreuth, 95447 Bayreuth, Germany; (P.Z.); (O.M.)
- Department of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria;
| |
Collapse
|
11
|
Kumar CM, Vohra SB, Farahmand Rad R. Vitreoretinal Surgery Under Sub-Tenon’s Block and Conscious Sedation in a Patient with Brugada Syndrome: A Case Report and Literature Review. Anesth Pain Med 2021; 11:e120217. [PMID: 35075419 PMCID: PMC8782191 DOI: 10.5812/aapm.120217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.
Collapse
Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
- Corresponding Author: : Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
| | - Shashi B Vohra
- Department of Anaesthesia, Critical Care and Pain Management, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Reza Farahmand Rad
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
12
|
Sigmundsson F, Kuchalik J, Fadl S, Holy M, Joelson A. The unique challenges of Brugada syndrome in spinal deformity surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
13
|
Yuasa H, Kitaura A, Kitayama C, Fuyuta M, Mino T, Okamoto K, Nakao S. A 32-Year-Old Man Diagnosed with Type II Brugada Syndrome on Preoperative Electrocardiogram 1 Week Before Elective Tympanoplasty. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927756. [PMID: 33737506 PMCID: PMC7988432 DOI: 10.12659/ajcr.927756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Male, 32-year-old Final Diagnosis: Brugada syndrome Symptoms: No specific symptoms Medication:— Clinical Procedure: — Specialty: Anesthesiology • Cardiology
Collapse
Affiliation(s)
- Haruyuki Yuasa
- Department of Anesthesiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Atsuhiro Kitaura
- Department of Anesthesiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Chiyako Kitayama
- Department of Anesthesiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masaki Fuyuta
- Department of Anesthesiology, Kindai University Faculity of Medicine, Osakasayama, Osaka, Japan
| | - Takashi Mino
- Department of Anesthesiology, Kindai University Faculity of Medicine, Osakasayama, Osaka, Japan
| | - Ken Okamoto
- Department of Anesthesiology, Kindai University Faculity of Medicine, Osakasayama, Osaka, Japan
| | - Shinichi Nakao
- Department of Anesthesiology, Kindai University Faculity of Medicine, Osakasayama, Osaka, Japan
| |
Collapse
|
14
|
Tuncalı B, Kökten G, Altın C. Anaesthetic Management of a Patient with Brugada Syndrome in Total Knee Arthroplasty. Turk J Anaesthesiol Reanim 2021; 49:70-73. [PMID: 33718910 PMCID: PMC7932709 DOI: 10.5152/tjar.2020.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/09/2020] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 52-year-old female diagnosed with Brugada syndrome (BrS) scheduled to undergo right total knee arthroplasty. General anaesthesia was induced and maintained with thiopental intravenous sodium + remifentanil and sevoflurane + remifentanil infusion, respectively. Rocuronium bromide was used as the muscle relaxant. The defibrillator was ready for use with the electrodes on the patient. Sugammadex was used for muscle relaxant antagonization. Postoperative analgesia was provided by intermittent morphine HCL via an epidural catheter, intravenous patient-controlled analgesia (Meperidine), and intravenous tenoxicam. The patient was discharged on the 6th day without any problem. Anaesthetic management of patients with BrS is challenging for anaesthesiologists, because fatal cardiac arrhythmias can be triggered by many drugs commonly used in the perioperative period such as bupivacaine, lidocaine, neostigmine, propofol, succinylcholine, ketamine, and tramadol. In these cases, a detailed preoperative evaluation including family history, avoidance of drugs triggering arrhythmia, taking precautions against arrhythmia, and using the agents that are reported to be safe are essential for patient safety.
Collapse
Affiliation(s)
- Bahattin Tuncalı
- Department of Anaesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Gizem Kökten
- Department of Anaesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Cihan Altın
- Department of Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
15
|
Bérat CM, Montealegre S, Wiedemann A, Nuzum MLC, Blondel A, Debruge H, Cano A, Chabrol B, Hoebeke C, Polak M, Stoupa A, Feillet F, Torre S, Boddaert N, Bruel H, Barth M, Damaj L, Abi-Wardé MT, Afenjar A, Benoist JF, Madrange M, Caccavelli L, Renard P, Hubas A, Nusbaum P, Pontoizeau C, Gobin S, van Endert P, Ottolenghi C, Maltret A, de Lonlay P. Clinical and biological characterization of 20 patients with TANGO2 deficiency indicates novel triggers of metabolic crises and no primary energetic defect. J Inherit Metab Dis 2021; 44:415-425. [PMID: 32929747 DOI: 10.1002/jimd.12314] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
TANGO2 disease is a severe inherited disorder associating multiple symptoms such as metabolic crises, encephalopathy, cardiac arrhythmias, and hypothyroidism. The mechanism of action of TANGO2 is currently unknown. Here, we describe a cohort of 20 French patients bearing mutations in the TANGO2 gene. We found that the main clinical presentation was the association of neurodevelopmental delay (n = 17), acute metabolic crises (n = 17) and hypothyroidism (n = 12), with a large intrafamilial clinical variability. Metabolic crises included rhabdomyolysis (15/17), neurological symptoms (14/17), and cardiac features (12/17; long QT (n = 10), Brugada pattern (n = 2), cardiac arrhythmia (n = 6)) that required intensive care. We show previously uncharacterized triggers of metabolic crises in TANGO2 patients, such as some anesthetics and possibly l-carnitine. Unexpectedly, plasma acylcarnitines, plasma FGF-21, muscle histology, and mitochondrial spectrometry were mostly normal. Moreover, in patients' primary myoblasts, palmitate and glutamine oxidation rates, and the mitochondrial network were also normal. Finally, we found variable mitochondrial respiration and defective clearance of oxidized DNA upon cycles of starvation and refeeding. We conclude that TANGO2 disease is a life-threatening disease that needs specific cardiac management and anesthesia protocol. Mechanistically, TANGO2 disease is unlikely to originate from a primary mitochondrial defect. Rather, we suggest that mitochondrial defects are secondary to strong extrinsic triggers in TANGO2 deficient patients.
Collapse
Affiliation(s)
- Claire-Marine Bérat
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Université de Paris, Paris, France
- Reference Center of inherited Metabolic Diseases, Necker-Enfants-Malades University hospital, APHP, Imagine Institute, Filière G2M, Paris, France
| | - Sebastian Montealegre
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Reference Center of inherited Metabolic Diseases, Necker-Enfants-Malades University hospital, APHP, Imagine Institute, Filière G2M, Paris, France
| | - Arnaud Wiedemann
- Department of Pediatric Intensive Care, Reference Center of Inherited Metabolic Disorders, INSERM U1256, Nancy Hospital, Nancy, France
| | | | - Amélie Blondel
- Department of Biochemistry, Necker-Enfants-Malades University Hospital, APHP, Filière G2M, Paris, France
| | - Hugo Debruge
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
| | - Aline Cano
- Reference Center of Inherited Metabolic Disorders, La Timone Hospital, Filière G2M, Marseille, France
| | - Brigitte Chabrol
- Reference Center of Inherited Metabolic Disorders, La Timone Hospital, Filière G2M, Marseille, France
| | - Célia Hoebeke
- Reference Center of Inherited Metabolic Disorders, La Timone Hospital, Filière G2M, Marseille, France
| | - Michel Polak
- Université de Paris, Paris, France
- Endocrinology Unit, Reference Center of Rare Endocrine Diseases of Growth and Development, Necker-Enfants-Malades, University hospital, APHP, Imagine Institute, Paris, France
| | - Athanasia Stoupa
- Université de Paris, Paris, France
- Endocrinology Unit, Reference Center of Rare Endocrine Diseases of Growth and Development, Necker-Enfants-Malades, University hospital, APHP, Imagine Institute, Paris, France
| | - François Feillet
- Department of Pediatric Intensive Care, Reference Center of Inherited Metabolic Disorders, INSERM U1256, Nancy Hospital, Nancy, France
| | - Stéphanie Torre
- Competence Center of Inherited Metabolic Disorders, Rouen Hospital, Filière G2M, Rouen, France
| | - Nathalie Boddaert
- Université de Paris, Paris, France
- Paediatric Radiology Department, Necker-Enfants-Malades University hospital, APHP and INSERM U1163, Imagine Institute, Paris, France
| | - Henri Bruel
- Pediatrics Department, Le Havre Hospital, Le Havre, France
| | - Magalie Barth
- Pediatrics Department, Angers Hospital, Angers, France
| | - Lena Damaj
- Pediatrics Department, Rennes Hospital, Rennes, France
| | | | - Alexandra Afenjar
- Reference Center of Cerebellar Malformations and Congenital Diseases, Trousseau Hospital, APHP, Paris, France
| | - Jean-François Benoist
- Department of Biochemistry, Necker-Enfants-Malades University Hospital, APHP, Filière G2M, Paris, France
| | - Marine Madrange
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Reference Center of inherited Metabolic Diseases, Necker-Enfants-Malades University hospital, APHP, Imagine Institute, Filière G2M, Paris, France
| | - Laure Caccavelli
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Reference Center of inherited Metabolic Diseases, Necker-Enfants-Malades University hospital, APHP, Imagine Institute, Filière G2M, Paris, France
| | - Perrine Renard
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
| | - Arnaud Hubas
- Genetics and Molecular Biology, Laboratoire de culture cellulaire, Hôpital Cochin, Paris, France
| | - Patrick Nusbaum
- Genetics and Molecular Biology, Laboratoire de culture cellulaire, Hôpital Cochin, Paris, France
| | - Clément Pontoizeau
- Department of Biochemistry, Necker-Enfants-Malades University Hospital, APHP, Filière G2M, Paris, France
| | - Stéphanie Gobin
- Genetics Department, Necker-Enfants-Malades University Hospital, APHP, Paris, France
| | - Peter van Endert
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Université de Paris, Paris, France
| | - Chris Ottolenghi
- Department of Biochemistry, Necker-Enfants-Malades University Hospital, APHP, Filière G2M, Paris, France
| | - Alice Maltret
- Cardiology Unit, Necker-Enfants-Malades University Hospital, APHP, Paris, France
| | - Pascale de Lonlay
- Inserm U1151, Institut Necker Enfants-Malades, Paris, France
- Université de Paris, Paris, France
- Reference Center of inherited Metabolic Diseases, Necker-Enfants-Malades University hospital, APHP, Imagine Institute, Filière G2M, Paris, France
| |
Collapse
|
16
|
Tsimploulis A, Rashba EJ, Rahman T, Almasry IO, Singh A, Fan R. Medication unmasked Brugada syndrome and cardiac arrest in a COVID-19 patient. HeartRhythm Case Rep 2020; 6:554-557. [PMID: 32837906 PMCID: PMC7245294 DOI: 10.1016/j.hrcr.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Eric J Rashba
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Tahmid Rahman
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Ibrahim O Almasry
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Abhijeet Singh
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| | - Roger Fan
- State University Hospital of New York at Stony Brook, Stony Brook, New York
| |
Collapse
|
17
|
Post-operative Brugada electrocardiographic pattern, polymorphic ventricular tachycardia, and sudden death in a child after administration of propofol anaesthesia. Cardiol Young 2020; 30:724-727. [PMID: 32216848 DOI: 10.1017/s1047951120000578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 9-year-old African-American girl presented with sudden cardiac arrest a few hours after adenotonsillectomy. She received anaesthesia which included propofol during the procedure. Her electrocardiogram (EKG) showed type 1 Brugada pattern, and genetic testing revealed a variant of unknown significance in desmoplakin (DSP) gene. We discuss the association between propofol, Brugada EKG pattern, and malignant ventricular arrhythmias.
Collapse
|
18
|
Drago F, Bloise R, Bronzetti G, Leoni L, Porcedda G, Sarubbi B, De Filippo P, Gulletta S, Scaglione M. Italian recommendations for the management of pediatric patients under twelve years of age with suspected or manifest Brugada syndrome. Minerva Pediatr 2020; 72:1-13. [DOI: 10.23736/s0026-4946.19.05759-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
19
|
The Use of Succinylcholine in Brugada Syndrome: A Case Report and Discussion of Literature. Case Rep Anesthesiol 2019; 2019:5182672. [PMID: 31772777 PMCID: PMC6854987 DOI: 10.1155/2019/5182672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/08/2019] [Indexed: 11/18/2022] Open
Abstract
We describe a patient with a major depression and a newly discovered Brugada syndrome, who was successfully treated with 35 electroconvulsive therapy sessions using succinylcholine as muscle relaxant. We discuss the use of succinylcholine in patients with Brugada syndrome.
Collapse
|
20
|
Ferreira MN, Fontes S, Machado H. Interscalene plexus block and general anesthesia in Brugada syndrome. Saudi J Anaesth 2019; 13:371-373. [PMID: 31572087 PMCID: PMC6753764 DOI: 10.4103/sja.sja_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Brugada syndrome (BrS) is a channelopathy predisposing to malignant ventricular arrhythmias and sudden cardiac death. Perioperative pharmacological and physiological changes may precipitate these events and cardiac dysfunction. We report the efficacy and safety interscalene brachial plexus block combined with general anesthesia in a patient with BrS. Awake and double-guided interscalene block was performed. After performing the block, general anesthesia was induced with fentanyl, propofol and rocuronium and maintained with oxygen-air/sevoflurane mixture. Sugammadex was administered for neuromuscular reversal. During perioperative period, the patient remained hemodynamically stable with anormal sinus rhythm and no ST segment changes. Hospital discharged occurred 36h after surgery without complications. General recommendations include avoidance of increased vagal tone, correction of electrolytes disturbances, maintenance of normothermia, normocapnia, adequate analgesia, and an adequately deep plane of anesthesia. Interscalene block combined with general anesthesia provided good analgesia, hemodynamic and cardiac electric stability.
Collapse
Affiliation(s)
- Mónica Nunes Ferreira
- Department of Anesthesiology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Portugal
| | - Sara Fontes
- Department of Anesthesiology, Centro Hospitalar do Porto, Portugal
| | - Humberto Machado
- Department of Anesthesiology, Centro Hospitalar do Porto, Portugal
| |
Collapse
|
21
|
Ward RA, Ajayi T, Aylward T, Byrns J, Summers BB, Wilder J. Multi-disciplinary approach to perioperative risk assessment and post-transplant management for liver transplantation in a patient at risk for Brugada syndrome. J Perioper Pract 2019; 29:140-146. [PMID: 30212282 DOI: 10.1177/1750458918796013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Brugada syndrome, an autosomal dominant genetic disorder, is characterised by abnormal electrocardiogram findings and increased risk of ventricular tachyarrhythmias and sudden cardiac death. Our report describes the multi-disciplinary perioperative management of a 28-year-old patient presenting to the Duke Transplant Center with a familial sodium channel gene SCN51 mutation concerning Brugada syndrome. We discuss the preparatory work-up, medication review and appropriate post-surgical follow-up for patients undergoing liver transplant surgery with cardiac monitoring.
Collapse
Affiliation(s)
- Rachael A Ward
- 1 Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Teminioluwa Ajayi
- 1 Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tanya Aylward
- 2 Department of Medicine, Duke University Hospital, Durham, NC, USA
| | - Jennifer Byrns
- 3 Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | | | - Julius Wilder
- 5 Duke Division of Gastroenterology, Duke University School of Medicine, Durham, NC, USA
- 6 Duke Clinical Research Institute, Durham, NC, USA
| |
Collapse
|
22
|
Marques da Costa F, Luís M, Lança F. Anaesthetic management of C-section in Brugada syndrome: When less is more. ACTA ACUST UNITED AC 2019; 66:338-341. [PMID: 30862400 DOI: 10.1016/j.redar.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/25/2018] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
Abstract
Brugada Syndrome (BrS) is a rare and high risk condition, seldom encountered in the delivery room. Pregnant patients with BrS benefit from the lowest possible doses of arrhythmogenic drugs such as local anesthetics. Based on this premise, the following case report exposes how a subarachnoid approach might be a desirable technique in C-section procedures for BrS patients. Pain and anxiety management are priorities in this specific population. Peri-partum planning, with a previous anesthesiology appointment and mutidisciplinary care in tertiary hospital facilities are crucial to avoid complications.
Collapse
Affiliation(s)
- F Marques da Costa
- Serviço de Anestesiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
| | - M Luís
- Serviço de Anestesiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - F Lança
- Serviço de Anestesiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| |
Collapse
|
23
|
Bignami E, Bellini V. Brugada Syndrome: a challenge for the anesthesiologists. Minerva Anestesiol 2019; 85:121-123. [PMID: 30621381 DOI: 10.23736/s0375-9393.18.13449-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Elena Bignami
- Unit of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy -
| | - Valentina Bellini
- Unit of Anesthesiology, Division of Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
24
|
Veselis RA. Complexities of human memory: relevance to anaesthetic practice. Br J Anaesth 2019; 121:210-218. [PMID: 29935575 DOI: 10.1016/j.bja.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/09/2018] [Accepted: 03/16/2018] [Indexed: 01/19/2023] Open
Abstract
Mechanisms of anaesthetic actions on memory have largely focused on easily definable aspects of episodic memory, with emphasis on particular drug interactions on specific memory processes. However, the memory landscape of the perioperative experience includes many facets that lie outside these conceptualisations. These include patient recall of preoperative conversations, patient beliefs regarding allergies and unusual/uncommon anaesthetic events, memories of awareness, and particularly vivid dreams during anaesthesia. In no small part, memories are influenced by a patient's interpretations of events in light of their own belief systems. From the practitioner's point of view, relating fully to the patient's experience requires some framework of understanding. The purpose of this review is to highlight research over the previous decades on belief systems and their interactions with autobiographical memory, which organises episodic memories into a personally relevant narrative. As a result, memory is a set of continuously malleable processes, and is best described as a (re)constructive rather than photographic instantiation. Belief systems are separate but closely interacting processes with autobiographical memory. The interaction of a constantly evolving set of memories with belief systems can explain phenomena such as illusions, distortions, and (re)constructions of factitious events. How anaesthetics and our patient interactions influence these behaviours, and vice versa, will be important questions to explore and define with future research.
Collapse
Affiliation(s)
- R A Veselis
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA.
| |
Collapse
|
25
|
Espinosa Á, Ripollés-Melchor J, Brugada R, Campuzano Ó, Sarquella-Brugada G, Abad-Motos A, Zaballos-García M, Abad-Torrent A, Prieto-Gundin A, Brugada J. Brugada Syndrome: anesthetic considerations and management algorithm. Minerva Anestesiol 2018; 85:173-188. [PMID: 30394071 DOI: 10.23736/s0375-9393.18.13170-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brugada Syndrome is characterized by arrhythmogenic risk that may be exacerbated by different metabolic and pharmacological factors. Since its first description, knowledge of this syndrome and its detection by physicians belonging to different specialties have gradually increased. The risk of arrhythmias is well known to increase in the postoperative period, and this risk is particularly accentuated in patients with Brugada Syndrome. The purpose of this review is to analyze the relationship between this syndrome and anesthesia; establish recommendations for the safe management of these patients in the surgical setting; and update the relevant concepts regarding the safety of drug administration in individuals with Brugada Syndrome.
Collapse
Affiliation(s)
- Ángel Espinosa
- Department of Cardiothoracic Anesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain.,Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain
| | - Javier Ripollés-Melchor
- Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain - .,Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Ramón Brugada
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain.,Department of Cardiology, Josep Trueta Hospital, Girona, Spain
| | - Óscar Campuzano
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain
| | - Georgia Sarquella-Brugada
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Ane Abad-Motos
- Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Matilde Zaballos-García
- Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain.,Clinical Toxicology, Madrid Complutense University, Madrid, Spain
| | - Ana Abad-Torrent
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Sant Joan de Déu Hospital, Barcelona Children's Hospital, Barcelona, Spain
| | - Josep Brugada
- Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| |
Collapse
|
26
|
Levy D, Bigham C, Tomlinson D. Anaesthesia for patients with hereditary arrhythmias part I: Brugada syndrome. BJA Educ 2018; 18:159-165. [PMID: 33456827 DOI: 10.1016/j.bjae.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/23/2022] Open
Affiliation(s)
- D Levy
- Torbay Hospital, Torquay, UK
| | - C Bigham
- Derriford Hospital, Plymouth, UK
| | | |
Collapse
|
27
|
Kwon HM, Kim SH, Park SU, Rhim JH, Park HS, Kim WJ, Nam GB. Propofol for implantable cardioverter defibrillator implantation in patients with Brugada syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:656-660. [DOI: 10.1111/pace.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/16/2018] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hye-Mee Kwon
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Se-Ung Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Jin-Ho Rhim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Hee-Sun Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Wook-Jong Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Gi-Byoung Nam
- Department of Internal Medicine (Cardiology), Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| |
Collapse
|
28
|
General and regional anaesthesia in Brugada Syndrome – A case report. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2017.10.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
29
|
Anesthesia and Brugada syndrome: Still some doubts. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2018. [DOI: 10.1016/j.tacc.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
Ciconte G, Santinelli V, Brugada J, Vicedomini G, Conti M, Monasky MM, Borrelli V, Castracane W, Aloisio T, Giannelli L, Di Dedda U, Pozzi P, Ranucci M, Pappone C. General Anesthesia Attenuates Brugada Syndrome Phenotype Expression: Clinical Implications From a Prospective Clinical Trial. JACC Clin Electrophysiol 2018; 4:518-530. [PMID: 30067493 DOI: 10.1016/j.jacep.2017.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/17/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study investigates the electrocardiographic-electrophysiological effects of administration of anesthetic drugs for general anesthesia (GA) in patients with BrS at high risk of sudden cardiac death (SCD). BACKGROUND The safety of anesthetic agents in Brugada syndrome (BrS) is under debate. METHODS All consecutive patients with spontaneous type 1 BrS electrocardiographic (ECG) patterns undergoing epicardial ablation of the arrhythmogenic substrate (AS) under GA were enrolled. Anesthesia was induced with single bolus of propofol and maintained with sevofluorane. ECG measurements were collected before, immediately after, and 20 min after induction of GA. Three-dimensional maps during GA and after ajmaline indicated the epicardial AS before ablation. RESULTS Thirty-six patients with BrS (32 male, 88.9%; mean age 38.8 ± 12.0 years) with a spontaneous type 1 ECG pattern underwent GA. Induction was performed using propofol at mean dose of 1.6 to 2.6 mg/kg (2.1 ± 0.3 mg/kg). Twenty-eight (28 of 36, 77.8%) patients showed a reversion to a nondiagnostic pattern. ST-segment elevation (0.32 ± 0.01 mV vs. 0.19 ± 0.02 mV; p < 0.001) and J-wave amplitude (0.47 ± 0.02 mV vs. 0.31 ± 0.03 mV; p < 0.001) decreased after propofol. The AS area during GA, in the absence of BrS pattern, significantly enlarged after administration of ajmaline (3.6 ± 0.5 cm2 vs. 20.3 ± 0.8 cm2). No patient developed malignant arrhythmias during GA induction and maintenance. CONCLUSIONS This study shows that GA using single-bolus propofol and volatile anesthetics is safe in high-risk patients with BrS, and it may exert a modulating effect by reducing the manifestation of type 1 BrS pattern and AS in the form of epicardial abnormal ECGs. (Epicardial Ablation in Brugada Syndrome: An Extension Study of 200 BrS Patients; NCT03106701).
Collapse
Affiliation(s)
- Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Manuel Conti
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Valeria Borrelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Walter Castracane
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Tommaso Aloisio
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Umberto Di Dedda
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Pozzi
- Johnson & Johnson, Biosense Webster, Pomezia, Rome, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
| |
Collapse
|
31
|
Sahutoglu C, Kocabas S, Askar FZ. Tramadol use in a patient with Brugada syndrome and morphine allergy: a case report. J Pain Res 2018; 11:191-194. [PMID: 29391825 PMCID: PMC5769782 DOI: 10.2147/jpr.s150905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Brugada syndrome is a rare syndrome characterized by arrhythmias and sudden death, particularly in younger individuals. A mutation in a gene encoding the human cardiac sodium channels is responsible for this syndrome. In the literature, there are several case reports of Brugada syndrome in association with the use of several anesthetic agents. Herein, we present our anesthetic practice and the use of tramadol in a 75-year-old female patient who underwent pulmonary lobectomy under general anesthesia and was diagnosed with Brugada syndrome.
Collapse
Affiliation(s)
- Cengiz Sahutoglu
- Ege University School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Seden Kocabas
- Ege University School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| | - Fatma Zekiye Askar
- Ege University School of Medicine, Department of Anesthesiology and Reanimation, Izmir, Turkey
| |
Collapse
|
32
|
Corey SA, Varkey S, Phillips DR, Gay GL. Brugada Syndrome Induced by an Interscalene Block: A Case Report. JBJS Case Connect 2017; 7:e96. [PMID: 29280897 DOI: 10.2106/jbjs.cc.17.00030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 57-year-old woman with no noteworthy medical or surgical history underwent an interscalene block with bupivacaine in preparation for an arthroscopic rotator cuff repair. Following administration of the bupivacaine, the patient sustained a ventricular fibrillation arrest. After successful cardiopulmonary resuscitation, she was diagnosed with Brugada syndrome. An implantable cardioverter-defibrillator was placed, and the rotator cuff repair was performed 1 month later. CONCLUSION Brugada syndrome is an abnormality of the cardiac conduction system that leads to cardiac arrhythmias. Several anesthetic agents trigger Brugada-like electrocardiographic abnormalities. To our knowledge, this is the first report of an interscalene block inducing Brugada syndrome.
Collapse
Affiliation(s)
- Sally A Corey
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - Santosh Varkey
- Departments of Cardiology (S.V.), Orthopaedic Surgery (D.R.P.), and Anesthesia (G.L.G.), University Hospital, Augusta, Georgia
| | - Douglas R Phillips
- Departments of Cardiology (S.V.), Orthopaedic Surgery (D.R.P.), and Anesthesia (G.L.G.), University Hospital, Augusta, Georgia
| | - Gregory L Gay
- Departments of Cardiology (S.V.), Orthopaedic Surgery (D.R.P.), and Anesthesia (G.L.G.), University Hospital, Augusta, Georgia
| |
Collapse
|
33
|
Dendramis G, Paleologo C, Sgarito G, Giordano U, Verlato R, Baranchuk A, Brugada P. Anesthetic and Perioperative Management of Patients With Brugada Syndrome. Am J Cardiol 2017; 120:1031-1036. [PMID: 28739038 DOI: 10.1016/j.amjcard.2017.06.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
Abstract
Brugada syndrome (BrS) is an arrhythmogenic disease reported to be one among the leading causes of cardiac death in subjects under the age of 40 years. In these patients, episodes of lethal arrhythmias may be induced by several factors or situations, and for this reason, management during anesthesia and surgery must provide some precautions and drugs restrictions. To date, it is difficult to formulate guidelines for anesthetic management of patients with BrS because of the absence of prospective studies, and there is not a definite recommendation for neither general nor regional anesthesia, and there are no large studies in merit. For this reason, in the anesthesia management of patients with BrS, the decision of using each drug must be made after careful consideration and always in controlled conditions, avoiding other factors that are known to have the potential to induce arrhythmias and with a close cooperation between anesthetists and cardiologists, which is essential before and after surgery. In conclusion, given the absence of large studies in literature, we want to focus on some general rules, which resulted from case series and clinical practice, to be followed during the perioperative and anesthetic management of patients with BrS.
Collapse
|
34
|
Abstract
Brugada syndrome (BrS) is an autosomal dominant inherited channelopathy. It is associated with a typical pattern of ST-segment elevation in the precordial leads V1-V3 and potentially lethal ventricular arrhythmias in otherwise healthy patients. It is frequently seen in young Asian males, in whom it has previously been described as sudden unexplained nocturnal death syndrome. Although it typically presents in young adults, it is also known to present in children and infants, especially in the presence of fever. Our understanding of the genetic pathogenesis and management of BrS has grown substantially considering that it has only been 24 years since its first description as a unique clinical entity. However, there remains much to be learned, especially in the pediatric population. This review aims to discuss the epidemiology, genetics, and pathogenesis of BrS. We will also discuss established standards and new innovations in the diagnosis, prognostication, risk stratification, and management of BrS. Literature search was run on the National Center for Biotechnology Information's website, using the Medical Subject Headings (MeSH) database with the search term "Brugada Syndrome" (MeSH), and was run on the PubMed database using the age filter (birth-18 years), yielding 334 results. The abstracts of all these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.
Collapse
Affiliation(s)
- Shashank P Behere
- Nemours Cardiac Center, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - Steven N Weindling
- The Pediatric Specialty Clinic, Overland Park Regional Medical Center, Overland Park, KS 66215, USA
| |
Collapse
|
35
|
Anesthesia and Brugada syndrome: a 12-year case series. J Clin Anesth 2017; 36:168-173. [DOI: 10.1016/j.jclinane.2016.09.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/27/2016] [Accepted: 09/28/2016] [Indexed: 11/18/2022]
|
36
|
Alzahrani T. Near miss in a patient with undiagnosed Brugada syndrome: a case report and literature review. J Clin Anesth 2016; 35:427-429. [DOI: 10.1016/j.jclinane.2016.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/17/2016] [Accepted: 09/06/2016] [Indexed: 11/25/2022]
|
37
|
Oliván B, Arbeláez A, de Miguel M, Pelavski A. Diagnosis of Brugada's syndrome after subarachnoid injection of prilocaine. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2016; 63:483-486. [PMID: 26778671 DOI: 10.1016/j.redar.2015.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/22/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
Brugada syndrome is an autosomal dominant genetic disease affecting sodium ion channels. It is characterised by right bundle branch block and ST elevation in the right precordial leads, and with no structural cardiac abnormalities. It is associated with sudden death. This disease may be unmasked by certain drugs and sudden changes in autonomic tone. Local anaesthetics may increase ECG changes due to a blockade of the sodium channels, mainly depending on the dose and the type of anaesthetic. Thus, there have been reported electrocardiographic changes consistent with Brugada syndrome, triggered after epidural or paravertebral infusion of bupivacaine and ropivacaine. The case is described of a 66 years old man, scheduled for inguinal herniorrhaphy as an outpatient. He had no history of syncope or arrhythmias. After spinal anaesthesia with 40mg of prilocaine the ECG showed ST elevation>2mm, and right bundle branch block in V1-V3.
Collapse
Affiliation(s)
- B Oliván
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - A Arbeláez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - M de Miguel
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Pelavski
- Servicio de Anestesiología y Reanimación, Hospital Universitario Vall d'Hebron, Barcelona, España
| |
Collapse
|
38
|
Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation. Case Rep Anesthesiol 2016; 2016:9278409. [PMID: 27668095 PMCID: PMC5030394 DOI: 10.1155/2016/9278409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/31/2016] [Accepted: 08/22/2016] [Indexed: 12/24/2022] Open
Abstract
SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.
Collapse
|
39
|
Sorajja D, Ramakrishna H, Poterack AK, Shen WK, Mookadam F. Brugada syndrome and its relevance in the perioperative period. Ann Card Anaesth 2016; 18:403-13. [PMID: 26139749 PMCID: PMC4881698 DOI: 10.4103/0971-9784.159812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.
Collapse
Affiliation(s)
| | | | | | | | - Farouk Mookadam
- Department of Anesthesiology, Mayo Clinic, Arizona, AZ 85259, USA
| |
Collapse
|
40
|
Şahinkaya HH, Yaşar E, Tekgül ZT, Horsanalı BÖ, Özeroğlu E. Anaesthetic Management of a Patient with Brugada Syndrome. Turk J Anaesthesiol Reanim 2016; 44:96-8. [PMID: 27366566 DOI: 10.5152/tjar.2016.22230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/23/2015] [Indexed: 11/22/2022] Open
Abstract
Brugada Syndrome is a condition with an undetermined aetiology and a tendency for malignant arrhythmias, an electrocardiographic pattern of a right bundle branch block with persistent ST segment elevation in the right precordial leads (V1-V3) and no association with structural heart disease. We aimed to discuss the anaesthetic management of an asymptomatic 35-year-old patient with Brugada syndrome who had been diagnosed during the pre-anaesthetic assessment because of the family history of the early sudden cardiac death of his mother. As a result, we believe that detailed patient history and careful examination of laboratory tests and electrocardiography are crucial for early diagnosis of some diseases and for successful anaesthetic management.
Collapse
Affiliation(s)
| | - Erdem Yaşar
- Department of Algology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Zeki Tuncel Tekgül
- Clinic of Anaesthesiology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | | | - Ertaç Özeroğlu
- Clinic of Anaesthesiology, Bozyaka Training and Research Hospital, İzmir, Turkey
| |
Collapse
|
41
|
Biricik E, Hatipoğlu Z, Küçükbingöz Ç. Sugammadex in a Patient with Brugada Syndrome. Turk J Anaesthesiol Reanim 2016; 44:99-101. [PMID: 27366567 DOI: 10.5152/tjar.2016.60973] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/14/2015] [Indexed: 11/22/2022] Open
Abstract
Brugada Syndrome was first described in 1992 by Pedro Brugada as a genetic syndrome that is characterized by ventricular arrhythmias that may result in sudden cardiac arrest. In particular, a right bundle branch block and ST segment elevation in the right precordial leads are observed. Many perioperative pharmalogical and physiological factors can trigger malignant arrhythmias. Although it is a rare condition, the anaesthestic management of Brugada syndrome is important because of the potentially fatal complications. Many anaesthetics have been administered during the operation of patients with Brugada Syndrome. The use of sugammadex instead of the anaesthetic management of patients with Brugada syndrome is discussed in this study.
Collapse
Affiliation(s)
- Ebru Biricik
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Zehra Hatipoğlu
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| | - Çağatay Küçükbingöz
- Department of Anaesthesiology and Reanimation, Çukurova University School of Medicine, Adana, Turkey
| |
Collapse
|
42
|
van Hoeijen DA, Blom MT, Tan HL. Cardiac sodium channels and inherited electrophysiological disorders: an update on the pharmacotherapy. Expert Opin Pharmacother 2014; 15:1875-87. [PMID: 24992280 DOI: 10.1517/14656566.2014.936380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Since the recognition of inherited sodium (Na(+)) channel disease, the cardiac Na(+) channel has been extensively studied. Both loss-of-function and gain-of-function mutations of the cardiac Na(+) channel are associated with cardiac arrhythmia and sudden cardiac death. Pathophysiological mechanisms that may induce arrhythmia are unravelled and include alterations in biophysical properties due to the mutation in SCN5A, drug use and circumstantial factors. Insights into the mechanisms of inherited Na(+) channel disease may result in tailored therapy. However, due to the complexity of cardiac electrical activity and pathophysiological mechanisms, pharmacotherapy in cardiac Na(+) channel disease remains challenging. AREAS COVERED This review discusses various mechanisms involved in inherited Na(+) channel disorders, focussing on Brugada syndrome (Brs) and long QT syndrome type 3 (LQTS3). It aims to provide an overview of developments in pharmacotherapy, discussing both treatment and which drugs to avoid to prevent arrhythmia. EXPERT OPINION Altered biophysical properties of cardiac Na(+) channels are the basis of arrhythmias in patients with inherited Na(+) channel diseases such as BrS and LQTS3. The effects of such biophysical derangements are strongly modulated by concomitant factors. Tailored drug therapy is required to prevent arrhythmia and is best achieved by educating patients affected by Na(+) channel disorders.
Collapse
Affiliation(s)
- Daniel A van Hoeijen
- University of Amsterdam, Academic Medical Center, Department of Cardiology , P.O. Box 22660, 1100 DD, Amsterdam , The Netherlands +0031 20 566 3264 ; +0031 20 566 9131 ;
| | | | | |
Collapse
|
43
|
Takaishi K, Kawahito S, Yamada H, Soeki T, Sata M, Kitahata H. Increase in prominence of electrocardiographic J waves after a single dose of propofol in a patient with early ventricular repolarisation. Anaesthesia 2013; 69:170-5. [DOI: 10.1111/anae.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/26/2022]
Affiliation(s)
- K. Takaishi
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
| | - S. Kawahito
- Department of Anaesthesiology; Tokushima University Hospital; Tokushima Japan
| | - H. Yamada
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - T. Soeki
- Department of Cardiovascular Medicine; Tokushima University Hospital; Tokushima Japan
| | - M. Sata
- Department of Cardiovascular Medicine; The University of Tokushima Graduate School; Tokushima Japan
| | - H. Kitahata
- Department of Dental Anaesthesiology; The University of Tokushima Graduate School; Tokushima Japan
| |
Collapse
|
44
|
The Lambeth Conventions (II): Guidelines for the study of animal and human ventricular and supraventricular arrhythmias. Pharmacol Ther 2013; 139:213-48. [DOI: 10.1016/j.pharmthera.2013.04.008] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 12/17/2022]
|
45
|
A novel anaesthetical approach to patients with brugada syndrome in neurosurgery. Case Rep Anesthesiol 2013; 2013:280826. [PMID: 23781349 PMCID: PMC3679816 DOI: 10.1155/2013/280826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Brugada syndrome (BrS) is one of the most common causes of sudden death in young people. It usually presents with life-threatening arrhythmias in subjects without remarkable medical history. The need for surgical treatment may unmask BrS in otherwise asymptomatic patients. The best anaesthesiological treatment in such cases is matter of debate. We report a case of neurosurgical treatment of cerebello pontine angle (CPA) tumor in a BrS patient, performed under total intravenous anesthesia (TIVA) with target controlled infusion (TCI) modalities, using midazolam plus remifentanil and rocuronium, without recordings of intraoperative ECG alterations in the intraoperative period and postoperative complications.
Collapse
|
46
|
Postema PG, Tan HL, Wilde AAM. Ageing and Brugada syndrome: considerations and recommendations. J Geriatr Cardiol 2013; 10:75-81. [PMID: 23610577 PMCID: PMC3627719 DOI: 10.3969/j.issn.1671-5411.2013.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/12/2013] [Accepted: 01/19/2013] [Indexed: 12/05/2022] Open
Abstract
Brugada syndrome is an inherited disease associated with an increased risk of lethal ventricular arrhythmias. Such arrhythmias stem from innate disruptions in cardiac electrophysiology. Typically, such arrhythmias occur in the third or fourth decade of life. However, Brugada syndrome may also affect geriatric patients. In this paper, we focus on the ageing patient with Brugada syndrome, and specifically, on the interaction between Brugada syndrome and the more usually acquired clinical problems that may occur with increasing age, such as the use of cardiovascular and non-cardiovascular drugs, or the need for surgery. Such common conditions may also disrupt cardiac electrophysiology, thereby conferring added risk for Brugada syndrome patients. We present some considerations and recommendations that may serve as guidance to address these complexities.
Collapse
Affiliation(s)
- Pieter G. Postema
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, P.O. box 22660, 1100 DD Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, P.O. box 22660, 1100 DD Amsterdam, The Netherlands
| | - Arthur AM Wilde
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| |
Collapse
|
47
|
Conde R, Pereira M. Anesthetic Management of a Patient with Brugada Syndrome - the Use of Sugammadex in Major Abdominal Surgery. Braz J Anesthesiol 2013; 63:159-60. [DOI: 10.1016/j.bjane.2013.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 11/29/2022] Open
|
48
|
Conde R, Pereira M. Anesthetic Management of a Patient with Brugada Syndrome - the Use of Sugammadex in Major Abdominal Surgery. Braz J Anesthesiol 2013; 63:159-60. [DOI: 10.1016/s0034-7094(13)70207-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
|
49
|
Fuyuta M, Nakao S, Takai N, Shiba M, Tanaka Y, Iwamoto T, Kurita T. Sudden cardiac arrest during general anesthesia in an undiagnosed Brugada patient. J Cardiothorac Vasc Anesth 2012; 27:1334-6. [PMID: 23063101 DOI: 10.1053/j.jvca.2012.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Masaki Fuyuta
- Department of Anesthesiology, Kinki University, Osaka, Japan
| | | | | | | | | | | | | |
Collapse
|