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General anesthesia for patients with Brugada syndrome. A report of six cases

[L’anesthésie générale chez des patients atteints du syndrome de Brugada. Présentation de six cas]

From the Department of Anesthesiology, Kitasato University Hospital, Kanagawa, Japan.

Address correspondence to: Dr. Hirotsugu Okamoto, Department of Anesthesiology, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 Japan. Phone: 42-778-8733; Fax: 42-778-9427; E-mail: okasuke{at}med.kitasato-u.ac.jp

Purpose: To review six cases of Brugada syndrome presenting for insertion of a cardioverter-defibrillator under general anesthesia.

Clinical features: All patients had a history of syncope, ST segment elevation in the right precordial lead of the electrocardiogram (ECG) which became prominent after a pilsicainide challenge test. Routine monitors, right precordial lead of the ECG and an external defibrillator were installed prior to anesthesia. We administered propofol/midazolam for induction, and propofol/sevoflurane combined with fentanyl for maintenance of anesthesia. Atropine and ephedrine were administered to decrease vagal tone. No ECG change or arrhythmia was observed perioperatively. After the successful implantation of the defibrillator, all patients were discharged without any adverse event.

Conclusion: By avoiding agents or conditions that may exacerbate Brugada syndrome during anesthesia, we were able to manage the patients uneventfully for implantation of a cardioverter-defibrillator.

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