Postoperative Death in a Patient with Unrecognized Arrhythmogenic Right Ventricular Dysplasia Syndrome

Toh, Khay-Wee; Nadesan, Kasinathan; Sie, M Y; Vijeyasingam, R.; Tan, Patrick Seow Koon

doi:10.1213/01.ane.0000132996.12248.b0

Cited by 8 publications

(3 citation statements)

References 16 publications

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“…99 107 Most reports of ARVD/C (Table 4) describe undiagnosed cases which were unmasked perioperatively. 93 105 108 109 Thiopental, 96 105 106 propofol, 109 and isoflurane 105 106 109 have all been given to patients with ARVD/C without being specifically implicated in any of the observed complications. Isoflurane has been used in critically ill ARVD/C patients.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

“…No adverse effects have been reported with vecuronium 96 and atracurium. 109 Succinylcholine and volatile agents do not trigger malignant hyperthermia in patients with mutations in cardiac ryanodine receptor-calcium release channel, so they are not contraindicated in patients with ARVD/C. 109 110 In contrast, halothane 96 and pancuronium are best avoided 108 because of possible arrhythmogenicity.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

“…Epidural analgesia has not been related to perioperative complications in patients with ARVD/C. 109 High doses of local anaesthetics should be avoided due to the possibility of cardiotoxicity, as is the addition of epinephrine. 99 Caution is needed if vasopressors are required for treatment of hypotension.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

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Perioperative management of hereditary arrhythmogenic syndromes

Staikou

Chondrogiannis

Mani

2012

British Journal of Anaesthesia

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Patients with inherited cardiac channel disorders are at high risk of perioperative lethal arrhythmias. Preoperative control of symptoms and a multidisciplinary approach are required for a well-planned management. Good haemodynamic monitoring, adequate anaesthesia and analgesia, perioperative maintenance of normocarbia, normothermia, and normovolaemia are important. In congenital long QT syndrome, torsades de pointes should be prevented with magnesium sulphate infusion and avoidance of drugs such as droperidol, succinylcholine, ketamine, and ondansetron. Propofol and epidural anaesthesia represent safe choices, while caution is needed with volatile agents. In Brugada syndrome, β-blockers, α-agonists, and cholinergic drugs should be avoided, while isoproterenol reverses the ECG changes. Propofol, thiopental, and volatiles have been used uneventfully. In congenital sick sinus syndrome, severe bradycardia resistant to atropine may require isoproterenol or epinephrine. Anaesthetics with vagolytic properties are preferable, while propofol and vecuronium should be given with caution due to risk of inducing bradyarrhythmias. Neuraxial anaesthesia should produce the least autonomic imbalance. Arrhythmogenic right ventricular dysplasia/cardiomyopathy induces ventricular tachyarrhythmias, which should be treated with β-blockers. Generally, β-adrenergic stimulation and catecholamine release should be avoided. Halothane and pancuronium are contraindicated, while large doses of local anaesthetics and epinephrine should be avoided in neuraxial blocks. In catecholaminergic polymorphic ventricular tachycardia, β-blocker treatment should be continued perioperatively. Catecholamine release and β-agonists, such as isoproterenol, should be avoided. Propofol and remifentanil are probably safe, while halothane and pancuronium are contraindicated. Regional anaesthesia, without epinephrine, is relatively safe. In suspicious cardiac deaths, postmortem examination and familial screening are recommended.

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Section: Anaesthetic Considerationsmentioning

confidence: 99%