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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.
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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
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2
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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.
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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
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Bhatia K, D'Souza R, Malhamé I, Thorne S. Anaesthetic considerations in pregnant patients with cardiac arrhythmia. BJA Educ 2023; 23:196-206. [PMID: 37124169 PMCID: PMC10140473 DOI: 10.1016/j.bjae.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- K. Bhatia
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R. D'Souza
- McMaster University, Hamilton, Ontario, Canada
| | - I. Malhamé
- McGill University Health Centre, Montreal, Quebec, Canada
| | - S. Thorne
- University of Toronto Pregnancy and Heart Disease Program, Mount Sinai and Toronto General Hospitals, Toronto, Ontario, Canada
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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
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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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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
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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
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Cavaliere F, Allegri M, Apan A, Calderini E, Carassiti M, Cohen E, Coluzzi F, Di Marco P, Langeron O, Rossi M, Spieth P, Turnbull D. A year in review in Minerva Anestesiologica 2019. Anesthesia, analgesia, and perioperative medicine. Minerva Anestesiol 2021; 86:225-239. [PMID: 32118384 DOI: 10.23736/s0375-9393.20.14424-9] [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)
- Franco Cavaliere
- Department of Cardiovascular and Thoracic Sciences, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Allegri
- Unità Operativa Terapia del Dolore della Colonna e dello Sportivo, Policlinic of Monza, Monza, Italy.,Italian Pain Group, Milan, Italy
| | - Alparslan Apan
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Giresun, Giresun, Turkey
| | - Edoardo Calderini
- Unit of Women-Child Anesthesia and Intensive Care, Maggiore Polyclinic Hospital, Ca' Granda IRCCS and Foundation, Milan, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University Hospital, Rome, Italy
| | - Edmond Cohen
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Flaminia Coluzzi
- Unit of Anesthesia, Department of Medical and Surgical Sciences and Biotechnologies, Intensive Care and Pain Medicine, Sapienza University, Rome, Italy
| | - Pierangelo Di Marco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiologic, and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Olivier Langeron
- Department of Anesthesia and Intensive Care, Henri Mondor University Hospital, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Marco Rossi
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy
| | - Peter Spieth
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Dresden, Dresden, Germany
| | - David Turnbull
- Department of Anaesthetics and Neuro Critical Care, Royal Hallamshire Hospital, Sheffield, UK
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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
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