Anesthesia for a Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

Dornan, R.I.P.

doi:10.1213/00000539-200209000-00009

Cited by 10 publications

(32 citation statements)

References 8 publications

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“…112 118 120 Preoperative stress and anxiety with subsequent tachycardia should be avoided by giving an anxiolytic, such as temazepam. 118 Propofol and remifentanil have been used as induction and maintenance agents in a patient with CPVT, without complications. 118 Centrally acting sympatholytic drugs, such as clonidine and dexmedetomidine, may be useful in an adrenergic-dependent syndrome, such as CPVT.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

Perioperative management of hereditary arrhythmogenic syndromes

Staikou

Chondrogiannis

Mani

2012

British Journal of Anaesthesia

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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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Section: Anaesthetic Considerationsmentioning

confidence: 99%

Perioperative management of hereditary arrhythmogenic syndromes

Staikou

Chondrogiannis

Mani

2012

British Journal of Anaesthesia

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“…Accordingly, dexmedetomidine was administered in the present case. Additionally, there are some reports that epidural anesthesia is effective for ventricular tachycardia [13,15,18]. However, an epidural catheter was not inserted in our case.…”

Section: Discussionmentioning

confidence: 72%

“…Positive-pressure ventilation may cause hypotension by reducing venous return. Treatment includes Trendelenburg positioning and appropriate fluid challenge [15]. Administration of a pure αadrenergic agonist, such as phenylephrine, may be safe in CPVT patients [15].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment includes Trendelenburg positioning and appropriate fluid challenge [15]. Administration of a pure αadrenergic agonist, such as phenylephrine, may be safe in CPVT patients [15]. As β-agonist drugs may induce fatal arrhythmia, hypotension secondary to bradycardia should be treated with atropine or pacing without βagonist drug use [15].…”

Section: Discussionmentioning

confidence: 99%

“…Administration of a pure αadrenergic agonist, such as phenylephrine, may be safe in CPVT patients [15]. As β-agonist drugs may induce fatal arrhythmia, hypotension secondary to bradycardia should be treated with atropine or pacing without βagonist drug use [15]. When arrhythmia occurs, intravenous β-blocker therapy is considered the first choice [10].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Anesthetic management of a child with catecholaminergic polymorphic ventricular tachycardia undergoing insertion of implantable cardioverter defibrillator : a case report

2020

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Background: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a fatal cardiac ion channelopathy that causes sudden unexpected death in the young. Case presentation: The patient was a 3-year-old girl with CPVT. Insertion of an implantable cardioverter defibrillator (ICD) using epicardial pacing was scheduled. After premedication of rectal midazolam was given, general anesthesia was induced with midazolam, fentanyl, and rocuronium, and maintained with midazolam, fentanyl, remifentanil, and rocuronium. The operation was performed without any complications. Dexmedetomidine and fentanyl were continuously infused after the operation until she was extubated in the morning of postoperative day 1. Fatal arrhythmia due to perioperative stress did not occur. Conclusions: We report the anesthetic management of a child with CPVT who underwent insertion of an ICD. CPVT-induced fatal arrhythmia did not occur perioperatively by carefully avoiding perioperative stress with premedication and post-operative sedation.

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Anesthetic management for inhibiting sympathetic activation in an adolescent patient diagnosed with catecholaminergic polymorphic ventricular tachycardia and undergoing left cardiac sympathetic denervation: A case report

Anesthesia for a Patient with Catecholaminergic Polymorphic Ventricular Tachycardia

Cited by 10 publications

References 8 publications

Perioperative management of hereditary arrhythmogenic syndromes

Perioperative management of hereditary arrhythmogenic syndromes

Anesthetic management of a child with catecholaminergic polymorphic ventricular tachycardia undergoing insertion of implantable cardioverter defibrillator : a case report

Anesthetic management for inhibiting sympathetic activation in an adolescent patient diagnosed with catecholaminergic polymorphic ventricular tachycardia and undergoing left cardiac sympathetic denervation: A case report

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