Brugada syndrome and anaesthesia A case report and review

ABSTRACT

Brugada Syndrome is an inherited form of cardiac disease characterized by arrhythmias and sudden death with a prevalence of 5 per 10.000. Although this condition is estimated to be responsible for 4%-12% of all sudden deaths in the general population, it is not commonly recognized because of limited reports in the literature. The Brugada syndrome is an increasingly recognized disorder and anaesthetists are likely to encounter this syndrome in practice, this review is to find out the implications of Brugada syndrome for anaesthesia and to outline recommendations for per operative anaesthetic management. We present a forty years old female who was successfully resuscitated after a community [ventricular fibrillation] VF arrest. The diagnosis Brugada Syndrome was confirmed with a flecainide provocation test and treated by insertion of an implantable defibrillator [ICD]. Two years later she had another VF arrest which was terminated by the implantable defibrillator [ICD]. In recent years [2000- 2006] less than two dozen cases have been reported, we reviewed published papers written in English language using journals and internet, using the wards anaesthesia and Brugada Syndrome. Drugs that are known triggers [e.g. class-IA and IC anti-arrhythmic drugs] should be avoided. Similarly, conditions that may provoke Brugada ECG like changes [e.g. hyper-and hypokalaemia, hypercalcaemia and hyperthermia] should be avoided. Implantation of ICD is currently the only proven effective therapy. Known patients of Brugada syndrome without an ICD should have external defibrillator paddles attached before commencing anaesthesia. Postoperative monitoring for 36-48 h is highly recommended as cardiac arrhythmias can occur during this time. This is particularly important when continuous infusions of local anaesthetic drug are used for regional blockade. Liaison with a cardiologist for both preoperative preparations and future follow-up improves outcome. The Brugada Syndrome should be excluded in patients with a family history of unexplained sudden death and in those with typical ST segment changes on ECG. Due to limited number of reports, the implications for anaesthesia are limited and it is difficult to draw firm conclusions: