Brugada electrocardiographic pattern in a postoperative patient*

Abstract

We postulated that the Brugada ECG abnormalities were induced primarily by an increase in parasympathetic tone resulting from vagal nerve manipulation during deep neck dissection and partially by the fever he developed during the postoperative period. In addition to the more common causes of ST-segment elevation, the Brugada ECG pattern or syndrome should be considered in patients undergoing deep neck dissection who develop characteristic ECG changes in association with normal cardiac enzymes and echocardiogram.

Brugada Syndrome: Overview

“…92 A number of Brugada patients displaying fever-induced polymorphic VT have been identified since the publication of this report. 14,38,[93][94][95][96][97][98][99][100] Mutations in the SCN5A gene account for approximately 18-30% of Brugada syndrome cases. A higher incidence of SCN5A mutations has been reported in familial than in sporadic cases.…”

Brugada syndrome and its relevance in the perioperative period

“…[ 27 28 ] Bradycardia, which may be a manifestation of this increased vagal tone, may be seen with the development of the Brugada ECG pattern. [ 45 54 ] A sudden rise in vagal activity immediately before the development of VF has been described in Brugada patients. [ 52 ] The intraoperative period is notable for multiple stressors, both leading to sympathetic activity (surgical incision, endotracheal intubation, anesthetic induction, and emergence) as well as sudden increases in parasympathetic tone (tracheal suctioning, peritoneal insufflation, and bowel retraction).…”

“…[ 47 ] Due to the risk of postoperative arrhythmias, continuous ECG monitoring should continue for up to 36 h postoperatively. [ 45 47 49 50 54 55 68 72 ] Sinus tachycardia and isolated premature ventricular complexes can be seen without increasing the occurrence of other more worrisome arrhythmias. [ 66 ]…”

A case of Brugada syndrome patient undertaken total intravenous anesthesia with remifentanil

“…An understanding of modulating agents and conditions is essential for planning of appropriate techniques and prevention of crisis. Depth of anesthesia should be balanced to minimize these effects, as bradycardia or increased vagal tone as a result of surgical stimulation have also been implicated in the development of Brugada ECG changes [4]. We used propofol-remifentanil for induction and maintenance of anesthesia because major advantages of TIVA are hemodynamic stability and reduced hemodynamic response during the emergence when compared with balanced anesthesia.…”

“…We used propofol-remifentanil for induction and maintenance of anesthesia because major advantages of TIVA are hemodynamic stability and reduced hemodynamic response during the emergence when compared with balanced anesthesia. Although, the most common opioid used in BS is fentanyl [4], Ahn and Kim [5] reported successful case of using remifentail. In our case, we successfully managed intubation, maintenance, and fully awake extubation without hemodynamic instabilities or tarchyarrhythmic events using TIVA.…”