Anesthetic Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disorder induced by adrenergic stress. Electrophysiologically, it is characterized by emotional stress- or exercise-induced bidirectional ventricular tachycardia that may result in cardiac arrest. Minimizing perioperative stress is critical as it can reduce fatal arrhythmias in patients with CPVT. Dexmedetomidine (DEX), a centrally acting sympatholytic anesthetic agent, was used in the successful intravenous (IV) moderate sedation of a 27-year-old female patient with CPVT, a history of cardiac events, and significant dental fear and anxiety scheduled to undergo mandibular left third molar extraction. Oral surgery was successfully performed under DEX-based IV sedation to reduce stress, and no arrhythmias were observed. IV sedation with DEX provided a sympatholytic effect with respiratory and cardiovascular stability in this patient with CPVT who underwent oral surgery.

Oral surgery under general anesthesia in a patient with catecholaminergic polymorphic ventricular tachycardia: A case report

“…Till date, only four cases have been reported as dental procedures for CPVT, two with general and two regional anesthesia (Table 1). Dexmedetomidine (DEX) with intravenous sedation has been used for treatment under local anesthesia, 9 and there have been case reports of DEX being used in general anesthesia to suppress sympathetic dominance on awakening 10 ; however, in our case, the patient had severe bradycardia, making it difficult to use DEX. During pediatric dental treatment of CPVT, a patient was safely treated under general anesthesia induced by nasal intubation after administering remifentanil, propofol, and rocuronium 1 .…”

Smooth Emergence from General Anesthesia after Deep Extubation in a Pediatric Patient Diagnosed with Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

“…The choice of anesthetic agents in CPVT patients should be carefully considered to avoid causing arrhythmias. Ketamine is commonly used for general anesthesia in pediatric patients but is not suitable for CPVT patients due to its stimulation of sympathetic nervous system activity [6,7]. Sevoflurane, propofol, and remifentanil can be safely used for the induction and maintenance of anesthesia in CPVT patients [4,7].…”

“…Ketamine is commonly used for general anesthesia in pediatric patients but is not suitable for CPVT patients due to its stimulation of sympathetic nervous system activity [6,7]. Sevoflurane, propofol, and remifentanil can be safely used for the induction and maintenance of anesthesia in CPVT patients [4,7]. Rocuronium, like other neuromuscular blocking agents, with the exception of pancuronium, can be safely used in CPTV patients [4].…”

“…Hypotension can occur during general anesthesia as a result of betablocker therapy, and positive-pressure ventilation can exacerbate this by reducing venous return [4,5]. The treatments for hypotension in CPVT patients include the Trendelenburg position, appropriate fluid administration, and the use of pure α-adrenergic agonists such as phenylephrine [4,5,7]. Hypotension caused by severe bradycardia should be treated with atropine or pacing [5,7].…”

“…The treatments for hypotension in CPVT patients include the Trendelenburg position, appropriate fluid administration, and the use of pure α-adrenergic agonists such as phenylephrine [4,5,7]. Hypotension caused by severe bradycardia should be treated with atropine or pacing [5,7]. However, β-adrenergic agonists should be avoided as they may trigger arrhythmias [4,5,7].…”