Anesthetic management of patients with Brugada syndrome: a case series and literature review

Abstract

In this series and in the literature, BrS patients tolerated anesthesia without untoward disease-related complications. Propofol and local anesthetics carry a theoretical risk of arrhythmogenic potential in BrS patients, but clear evidence is lacking. However, awareness of their potential to induce arrhythmias warrants caution, especially with propofol infusions. Factors that might exacerbate ST segment elevations and subsequently lead to dysrhythmias (e.g., hyperthermia, bradycardia, and electrolyte imbalances, such as hyper- and hypokalemia and hypercalcemia) should be avoided or corrected.

A Case Report on Brugada Syndrome and Anesthesia Considerations

“…Propofol, the commonly used hypnotic agent has the potential to alter ion channel function inducing Brugada-like ECG abnormalities, which can exacerbate the risk of malignant arrhythmias in BrS patients [1,3]. While the literature review supports the avoidance of propofol on induction and maintenance, no ST changes were noted on induction with its use on this patient.…”

“…The administration of propofol and neostigmine has also shown to induce arrhythmias on some BrS patients according to the evidence from the literature [2,3]. Therefore, this case report focuses on the challenges faced by the anesthesia providers in administering safe anesthesia to BrS patients and make recommendations for alternative anesthetic agents that could be considered on BrS patients in order to minimize their risks under anesthesia.…”

“…concerns because anesthesia providers routinely administer drugs that interact with cardiac ion channels, potentially triggering the development of malignant arrhythmias [1][2][3][4]. History of previous surgeries done uneventfully under general anesthesia do not lower the risks of subsequent adverse events in future [1].…”

“…Thus, the evidence from case reports cautions the use of class I antiarrhythmic agents, propofol, and neostigmine on BrS patients due to its tendencies to induce fatal arrhythmias and augment ST segment changes [1,3]. Therefore, it is best to avoid these agents on BrS patients.…”

“…Edrophonium may be considered over neostigmine as a possible choice to antagonize the neuromuscular blockade. Thus, anesthetic agents that might exacerbate ST segment elevations and lead to dysrhythmias such as lidocaine, propofol, and neostigmine should be avoided and replaced with safer alternatives while achieving amnesia, analgesia, sedation, and muscle relaxation [1][2][3].…”