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Park S, Heo W, Shin SW, Kim HJ, Yoo YM, Kim HY. General anesthesia using propofol infusion for implantation of an implantable cardioverter defibrillator in a pediatric patient with Andersen-Tawil syndrome: a case report. J Dent Anesth Pain Med 2023; 23:45-51. [PMID: 36819605 PMCID: PMC9911964 DOI: 10.17245/jdapm.2023.23.1.45] [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: 10/18/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 02/05/2023] Open
Abstract
Andersen-Tawil syndrome (ATS) is a rare genetic disease characterized by a triad of episodic flaccid muscle weakness, ventricular arrhythmias, and physical anomalies. ATS patients have various cardiac arrhythmias that can cause sudden death. Implantation of an implantable cardioverter-defibrillator (ICD) is required when life-threatening cardiac arrhythmias do not respond to medical treatment. An 11-year-old girl underwent surgery for an ICD implantation. For general anesthesia in ATS patients, anesthesiologists should focus on the potentially difficult airway, serious cardiac arrhythmias, such as ventricular tachycardia (VT), and delayed recovery from neuromuscular blockade. We followed the difficult airway algorithm, avoided drugs that can precipitate QT prolongation and fatal cardiac arrhythmias, and tried to maintain normoxia, normocarbia, normothermia, normoglycemia, and pain control for prevention of sympathetic stimulation. We report the successful application of general anesthesia for ICD implantation in a pediatric patient with ATS and recurrent VT.
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Affiliation(s)
- Seyeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Wonjae Heo
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sang-Wook Shin
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Hye-Jin Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Yeong Min Yoo
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.,Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Yangsan, Republic of Korea
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2
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Dell'Olio F, Lorusso P, Barile G, Favia G. Brugada Syndrome Updated Risk Assessment and Perioperative Management in Oral Surgery: A Case Series. J Oral Maxillofac Surg 2021; 79:2269.e1-2269.e11. [PMID: 34453905 DOI: 10.1016/j.joms.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Brugada syndrome (BrS) carries the risk of major dysrhythmias increased further by exposure to pro-dysrhythmic factors related to oral surgical procedures such as local anesthetics, anxiety, and postoperative pain. Such risk can be handled by updated multidisciplinary management. In 2020, 3 male BrS patients needed oral surgical treatments at the Complex Unit of Odontostomatology of Aldo Moro University of Bari, Italy. Multidisciplinary individual risk assessment involved cardiologic hazard ratio stratification, event-free survival stratification, and 5-year average risk of ventricular dysrhythmias and sudden cardiac death for Brugada patients; American Society of Anesthesiologists physical status risk class; expected complexity and duration of the procedure; and anxiety score measured by the Modified Dental Anxiety Scale. The authors administered conscious sedation by intravenous diazepam to both a patient susceptible to vasovagal syncope needing tooth extraction with concomitant cystectomy (longer-lasting procedure) and to another who needed routine tooth extraction (brief procedure) but had a moderate dental anxiety score; the last 1 received local anesthesia alone due to his low anxiety, low susceptibility to vasovagal syncope, and need for routine tooth extraction. After positioning external biphasic defibrillator pads, 12-leads continuous electrocardiogram, and peripheral venous access, extractions were performed with local anesthesia by lidocaine 2% with epinephrine 1:100,000; acetaminophen was suggested for postoperative analgesia. No electrocardiographic changes occurred in the perioperative period. The current multidisciplinary individual risk assessment allowed us to detect each BrS patient's risk factors for major dysrhythmias and to adapt oral surgical and anesthesiologic protocols for safe targeted treatment.
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Affiliation(s)
- Fabio Dell'Olio
- Oral Surgery Resident, Complex Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy.
| | - Pantaleo Lorusso
- Assistant at the chair of Anesthesiology, Unit of Anesthesiology, Department of Emergency, University of Bari Aldo Moro, Italy
| | - Giuseppe Barile
- Oral Surgery Resident, Complex Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy
| | - Gianfranco Favia
- Oral Surgery Resident, Complex Unit of Odontostomatology, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Italy
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3
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Oliveira ACG, Neves ILI, Sacilotto L, Olivetti NQS, Santos-Paul MAD, Montano TCP, Carvalho CMA, Wu TC, Grupi CJ, Barbosa SA, Pastore CA, Samesima N, Hachul DT, Scanavacca MI, Neves RS, Darrieux FCC. Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single-Center Study. J Am Heart Assoc 2019; 8:e012361. [PMID: 31319747 PMCID: PMC6761655 DOI: 10.1161/jaha.119.012361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Brugada syndrome and long-QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life-threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life-threatening arrhythmias in patients with channelopathies. Methods and Results We performed a randomized, double-blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty-eight-hour Holter monitoring was performed, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty-six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long-QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9±15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute (P=0.008). In patients with long-QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms (P=0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life-threatening arrhythmias occurred during dental treatment. Conclusions The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life-threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03182777.
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Affiliation(s)
- Ana Carolina Guimarães Oliveira
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Itamara Lucia Itagiba Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Luciana Sacilotto
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Natália Quintella Sangiorgi Olivetti
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Marcela Alves Dos Santos-Paul
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tânia Cristina Pedroso Montano
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cíntia Maria Alencar Carvalho
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tan Chen Wu
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cesar José Grupi
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Sílvio Alves Barbosa
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Carlos Alberto Pastore
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Nelson Samesima
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Denise Tessariol Hachul
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Maurício Ibrahim Scanavacca
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Ricardo Simões Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Francisco Carlos Costa Darrieux
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
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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.
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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
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5
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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.
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6
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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]
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7
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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.
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Affiliation(s)
| | | | | | | | - Farouk Mookadam
- Department of Anesthesiology, Mayo Clinic, Arizona, AZ 85259, USA
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8
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Shah AH, Khalil HS, Kola MZ. Dental management of a patient fitted with subcutaneous Implantable Cardioverter Defibrillator device and concomitant warfarin treatment. Saudi Dent J 2015; 27:165-70. [PMID: 26236132 PMCID: PMC4501466 DOI: 10.1016/j.sdentj.2014.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/18/2014] [Accepted: 11/19/2014] [Indexed: 11/16/2022] Open
Abstract
Automated Implantable Cardioverter Defibrillators (AICD), simply known as an Implantable Cardioverter Defibrillator (ICD), has been used in patients for more than 30 years. An Implantable Cardioverter Defibrillator (ICD) is a small battery-powered electrical impulse generator that is implanted in patients who are at a risk of sudden cardiac death due to ventricular fibrillation, ventricular tachycardia or any such related event. Typically, patients with these types of occurrences are on anticoagulant therapy. The desired International Normalized Ratio (INR) for these patients is in the range of 2–3 to prevent any subsequent cardiac event. These patients possess a challenge to the dentist in many ways, especially during oral surgical procedures, and these challenges include risk of sudden death, control of post-operative bleeding and pain. This article presents the dental management of a 60 year-old person with an ICD and concomitant anticoagulant therapy. The patient was on multiple medications and was treated for a grossly neglected mouth with multiple carious root stumps. This case report outlines the important issues in managing patients fitted with an ICD device and at a risk of sudden cardiac death.
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Affiliation(s)
- Altaf Hussain Shah
- Department of Preventive Dental Sciences, Salman bin Abdulaziz University, AlKharj, Saudi Arabia
| | - Hesham Saleh Khalil
- Department of Maxillofacial Surgery, College of Dentistry, King Saud University, Saudi Arabia
| | - Mohammed Zaheer Kola
- Department of Prosthodontic Dental Sciences, College of Dentistry, Salman bin Abdulaziz University, AlKharj, Saudi Arabia
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9
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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.
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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 ;
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10
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FLAMÉE PANAGIOTIS, DE ASMUNDIS CARLO, BHUTIA JIGMET, CONTE GIULIO, BECKERS STEFAN, UMBRAIN VINCENT, VERBORGH CHRISTIAN, CHIERCHIA GIANBATTISTA, VAN MALDEREN SOPHIE, CASADO-ARROYO RUBÉN, SARKOZY ANDREA, BRUGADA PEDRO, POELAERT JAN. Safe Single-Dose Administration of Propofol in Patients with Established Brugada Syndrome: A Retrospective Database Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1516-21. [DOI: 10.1111/pace.12246] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/28/2013] [Accepted: 07/07/2013] [Indexed: 01/07/2023]
Affiliation(s)
- PANAGIOTIS FLAMÉE
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - CARLO DE ASMUNDIS
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - JIGME T. BHUTIA
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - GIULIO CONTE
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - STEFAN BECKERS
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - VINCENT UMBRAIN
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - CHRISTIAN VERBORGH
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - GIAN-BATTISTA CHIERCHIA
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - SOPHIE VAN MALDEREN
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - RUBÉN CASADO-ARROYO
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - ANDREA SARKOZY
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - PEDRO BRUGADA
- Heart Rhythm Management Centre, Centrum Hart- en Vaatziekten, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
| | - JAN POELAERT
- Department of Anaesthesiology, Universitair Ziekenhuis Brussel; Vrije Universiteit Brussel; Laarbeeklaan Brussels Belgium
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11
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Sims PG, Kates CH, Moyer DJ, Rollert MK, Todd DW. Anesthesia in outpatient facilities. J Oral Maxillofac Surg 2013; 70:e31-49. [PMID: 23128005 DOI: 10.1016/j.joms.2012.07.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Staikou C, Chondrogiannis K, Mani A. Perioperative management of hereditary arrhythmogenic syndromes. Br J Anaesth 2012; 108:730-44. [PMID: 22499746 DOI: 10.1093/bja/aes105] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Patients with inherited cardiac channel disorders are at high risk of perioperative lethal arrhythmias. Preoperative control of symptoms and a multidisciplinary approach are required for a well-planned management. Good haemodynamic monitoring, adequate anaesthesia and analgesia, perioperative maintenance of normocarbia, normothermia, and normovolaemia are important. In congenital long QT syndrome, torsades de pointes should be prevented with magnesium sulphate infusion and avoidance of drugs such as droperidol, succinylcholine, ketamine, and ondansetron. Propofol and epidural anaesthesia represent safe choices, while caution is needed with volatile agents. In Brugada syndrome, β-blockers, α-agonists, and cholinergic drugs should be avoided, while isoproterenol reverses the ECG changes. Propofol, thiopental, and volatiles have been used uneventfully. In congenital sick sinus syndrome, severe bradycardia resistant to atropine may require isoproterenol or epinephrine. Anaesthetics with vagolytic properties are preferable, while propofol and vecuronium should be given with caution due to risk of inducing bradyarrhythmias. Neuraxial anaesthesia should produce the least autonomic imbalance. Arrhythmogenic right ventricular dysplasia/cardiomyopathy induces ventricular tachyarrhythmias, which should be treated with β-blockers. Generally, β-adrenergic stimulation and catecholamine release should be avoided. Halothane and pancuronium are contraindicated, while large doses of local anaesthetics and epinephrine should be avoided in neuraxial blocks. In catecholaminergic polymorphic ventricular tachycardia, β-blocker treatment should be continued perioperatively. Catecholamine release and β-agonists, such as isoproterenol, should be avoided. Propofol and remifentanil are probably safe, while halothane and pancuronium are contraindicated. Regional anaesthesia, without epinephrine, is relatively safe. In suspicious cardiac deaths, postmortem examination and familial screening are recommended.
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Affiliation(s)
- C Staikou
- Department of Anaesthesia, Aretaieio Hospital, Medical School, University of Athens, 76 Vassilissis Sophias Ave., 11528 Athens, Greece.
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13
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Carey SM, Hocking G. Brugada Syndrome – A Review of the Implications for the Anaesthetist. Anaesth Intensive Care 2011; 39:571-7. [DOI: 10.1177/0310057x1103900406] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Brugada syndrome is characterised by specific electrocardiogram changes in the right precordial leads, a structurally normal heart and susceptibility to ventricular arrhythmias that may cause syncope or sudden death in otherwise fit young adults. Perioperative pharmacological and physiological changes may precipitate these events. Arrhythmias and symptoms typically occur at rest or sleep when vagal activity predominates. Although the condition is rare, the implications are serious and may result in death. Individual case reports describe diverse anaesthetic management. In this paper we critically appraise the literature to identify unifying features and determine whether specific management can be recommended. We found 18 clinical reports of anaesthesia including a total of 28 patients, most under general anaesthesia. Those with an implanted defibrillator should have it deactivated. All patients should have external defibrillator pads applied continuously throughout the perioperative period. Electrolyte imbalances should be corrected preoperatively. Propofol infusions for maintenance of general anaesthesia are probably safe if duration and dose are limited. Sevoflurane may be the preferred volatile anaesthetic. Autonomic changes, inadequate analgesia, light anaesthesia and postural changes should be all be minimised. The patient should be warmed or cooled to maintain normothermia. An isoprenaline infusion is advocated for intraoperative ST changes. Regional anaesthesia is possible if the dose is limited and systemic absorption restricted. Lignocaine is the drug of choice while bupivacaine is relatively contraindicated. Ropivacaine is possibly also not safe. Prolonged regional anaesthesia may therefore require continuous catheter techniques. Five-lead electrocardiogram monitoring and ST trend analysis should continue into the postoperative period.
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Affiliation(s)
- S. M. Carey
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - G. Hocking
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Western Australia and Specialist Anaesthetist, Sir Charles Gairdner Hospital
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Anesthetic management of patients with Brugada syndrome: a case series and literature review. Can J Anaesth 2011; 58:824-36. [DOI: 10.1007/s12630-011-9546-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022] Open
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