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

Purpose: To review the anesthetic management and perioperative outcomes of patients diagnosed with Brugada syndrome (BrS) who were treated at a single centre and to compare those results with a comprehensive review of the existing literature. Clinical features: A retrospective chart review of anesthesia records from patients diagnosed with BrS at the Mayo Clinic was undertaken with the emphasis on administered drugs, ST segment changes, and occurrence of complications, including death, hemodynamic instability, and dysrhythmias. Eight patients were identified who underwent a total of 17 operative procedures from 2000 through 2010. A total of 20 significant ST segment elevations were recorded in four patients, several of which occurred in close temporal relation to anesthetic drug administration. These elevations resolved uneventfully. There were no recorded dysrhythmias, and recovery from anesthesia proceeded uneventfully. A literature review of patients with BrS yielded 52 anesthetics in 43 patients. The only recorded complications included unmasking of a Brugada ECG pattern, one episode of polymorphic ventricular tachycardia, which converted spontaneously to sinus rhythm, and one episode of postoperative ventricular fibrillation in the setting of epidural anesthesia. Conclusions: 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.