Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome

Abstract

Background Long QT syndrome (LQTS) is an inherited disorder of the heart’s electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. The clinical symptoms of LQTS are heart palpitations, syncope, anoxic seizures secondary to ventricular arrhythmia, and torsades de pointes. Case: We present here a 17-month-old male patient with bilateral sensorineural hearing loss who underwent general anesthesia for a cochlear implant. The surgical team was advised about the possible risks of using local anesthesia without adrenaline. A defibrillator, which was checked for pediatric use, was made available in the operating room. After the vascular access was opened, the patient was provided with induction propofol, remifentanil, and rocuronium, and anesthesia was maintained using an intravenous anesthetic. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex. Discussion LQTS patients have developed arrhythmia and sudden cardiac arrest from administration of sevoflurane and neostigmine during anesthesia. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied. In addition, a defibrillator was available for immediate use during the perioperative period. Conclusion Anesthesia can be safe by using intravenous rocuronium and sugammadex and local anesthetic without adrenaline.