|
1
|
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
|
|
3
|
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
|