Anesth Analg 2006;102:1590-1591
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000215196.42122.05
LETTER TO THE EDITOR
Ventricular Tachycardia in a Patient with Brugada Syndrome During General Anesthesia Combined with Thoracic Paravertebral Block
Yoshihiro Fujiwara, MD, PhD,
Yasuyuki Shibata, MD,
Shuji Kurokawa, MD,
Yuko Satou, MD, and
Toru Komatsu, MD, PhD
Department of Anesthesiology, Aichi Medical University, Aichi, Japan, yyoshiff@aichi-med-u.ac.jp
To the Editor:
Brugada syndrome is a hereditary disease characterized by right bundle branch block and ST-T segment elevation in the right precordial leads of the electrocardiogram (ECG) without any apparent structural abnormality in the heart (1). Although some authors have reported successful management of patients with Brugada syndrome during general or regional anesthesia (2–4), there have been no previous reports of a malignant arrhythmia during anesthesia in this population. This is the first report of ventricular tachycardia during general anesthesia combined with thoracic paravertebral block in a patient with criteria for Brugada syndrome in their ECG.
A 68-yr-old male with gastric cancer presented for distal gastrectomy. He was physically active and had no history of syncope or arrhythmia. However, his preoperative ECG showed ST elevation (>0.2 mV) in the V1 and V2 leads associated with an inverted T wave that is characteristic of Brugada syndrome (Fig. 1).
General anesthesia was induced with propofol, fentanyl, and vecuronium. After tracheal intubation, anesthesia was maintained with 0.5%–1.2% sevoflurane supplemented with fentanyl. A bilateral thoracic paravertebral block was performed with 40 mL of 0.5% ropivacaine at T8. Thirty minutes after skin incision, dopamine (3 µg · kg–1 · min–1) was initiated because of persistent hypotension and bradycardia. Twenty minutes after dopamine was started, the patient developed sudden polymorphic ventricular tachycardia (Fig. 2). The cardiac rhythm spontaneously converted between sinus and ventricular tachycardia several times and finally sinus rhythm was maintained. The patient spontaneously awoke from general anesthesia without neurological consequences or further cardiovascular consequences. The patient was transferred to the intensive care unit, where the dopamine was discontinued. There were no further episodes of arrhythmia. Subsequent echocardiography confirmed that there was no structural abnormality of the heart, establishing the diagnosis of Brugada syndrome.
References
- Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome: a multicenter report. J Am Coll Cardiol 1992;20:1391–6.[Abstract]
- Kim JS, Park SY, Min SK, et al. Anaesthesia in patients with Brugada syndrome. Acta Anaesthesiol Scand 2004;48:1058–61.[Medline]
- Santambrogio LG, Mencherini S, Fuardo M, et al. The surgical patient with Brugada syndrome: a four-case clinical experience. Anesth Analg 2005;100:1263–6.[Abstract/Free Full Text]
- Inamura M, Okamoto H, Kuroiwa M, Hoka S. General anesthesia for patients with Brugada syndrome: a report of six cases. Can J Anaesth 2005;52:409–12.[Medline]
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