Brugada syndrome and its relevance in the perioperative period

Abstract

Brugada syndrome is an autosomal dominant genetic disorder associated with an increased risk of sudden cardiac death, as well as ventricular tachyarrhythmias. The defective cardiac sodium channels result in usual electrocardiographic findings of a coved-type ST elevation in precordial leads V1 to V3. The majority of patients have uncomplicated courses with anesthesia, surgery, and invasive procedures. However there is risk of worsening ST elevation and ventricular arrhythmias due to perioperative medications, surgical insult, electrolyte abnormalities, fever, autonomic nervous system tone, as well as other perturbations. Given the increasing numbers of patients with inherited conduction disorders presenting for non-cardiac surgery that are at risk of sudden cardiac death, safe anesthetic management depends upon a detailed knowledge of these conditions.

The Use of Succinylcholine in Brugada Syndrome: A Case Report and Discussion of Literature

“…Also, the incidence of malignant hyperthermia is extremely low. General literature on anesthesia in Brugada syndrome patients does not advise against the use of succinylcholine [7–9]. Several case studies and series have been published in which succinylcholine was used without complications [7, 10, 11].…”

“…General literature on anesthesia in Brugada syndrome patients does not advise against the use of succinylcholine [7–9]. Several case studies and series have been published in which succinylcholine was used without complications [7, 10, 11]. Therefore, succinylcholine is currently not categorized in the lists of medication that is to be (preferably) avoided, as provided by BrugadaDrugs.org, a website developed in collaboration with a panel of world-renowned experts on Brugada syndrome and broadly acknowledged in literature and guidelines [12].…”

Epidural Analgesia with Ropivacaine during Labour in a Patient with a SCN5A Gene Mutation

“…In BrS patients, it is important that even the smallest ECG changes should be noticed and in case of changes epidural infusion must be discontinued [ 11 ]. For the perioperative monitoring, multilead ECG, preferably with ST trend analysis of the right cardiac leads, is advised [ 4 , 19 ]. In this case, we did not perform but it is advisable in next cases.…”

Brugada Pattern Type 2 Diagnosis Unmasked by Aspiration Pneumonia

“…Brugada syndrome (BrS) was initially described by Pedro and Joseph Brugada in 1992 [1]. BrS is an autosomal dominant mutation affecting sodium channels, which can provoke sudden cardiac arrest (SCA) owing to ventricular arrhythmia [1,2]. Electrocardiographic (ECG) characteristics of BrS can follow one of two Brugada patterns (BrP): the type 1 pattern features a coved-type ST segment, while the type 2 BrP features a saddleback ST segment in precordial leads V1-V3 [3].…”