Perioperative complications in patients with left ventricular non-compaction.

BACKGROUND AND OBJECTIVE: Left ventricular non-compaction (LVNC) is a relatively uncommon cardiomyopathy. The implications of the presence of LVNC in the perioperative period are unknown. The objective of this study was to determine the impact of LVNC on post-operative complications. METHODS: This retrospective cohort study identified patients with an echocardiographic diagnosis of LVNC who had an anaesthetic between 2001 and 2008. For each patient, all surgical procedures during this time were reviewed. Patient demographics, echocardiographic data, details of the procedure and anaesthetic and perioperative complications were recorded. We then compared the rate of perioperative complications in patients with LVNC with established complication rates in the existing literature. RESULTS: During the study period, 60 patients with LVNC underwent 220 procedures. Nineteen patients experienced a total of 25 complications, of which eight were directly related to the procedure and considered unrelated to LVNC. Of the remaining 17 complications (in 15 patients), there were 10 new arrhythmias, five respiratory complications, one seizure and one episode of syncope. Nearly half (47%) of the complications followed open cardiac surgery with cardiopulmonary bypass. All complications occurred in association with procedures performed under general anaesthesia; none occurred in patients undergoing regional anaesthesia or monitored anaesthesia care (sedation). There was no long-term morbidity and no peri-operative mortality. CONCLUSION: As the awareness and diagnosis of this condition increase, anaesthesiologists will probably care for growing numbers of patients with LVNC. We found that the incidence of post-operative complication in patients with LVNC undergoing a variety of procedures was low and no different from the published complication rates for other patients undergoing similar procedures.

Anesthesia considerations for patients with de Barsy syndrome.

STUDY OBJECTIVE: To determine anesthetic considerations for patients with de Barsy syndrome, a rare complex whose hallmark findings include cutis laxa, progeria, and multiple orthopedic and ophthalmologic abnormalities. DESIGN: Retrospective chart review. SETTING: Medical center. MEASUREMENTS: A search of Mayo Clinic medical records from 1968 to 2007 identified two patients with de Barsy syndrome who underwent a combined total of 35 anesthetics for diagnostic and surgical procedures. Data collected included: age, gender, ASA physical status, relevant comorbidities, surgical procedures, airway management, vascular access, monitoring, anesthetic induction, maintenance, and other observations. MAIN RESULTS: A wide range of anesthetics and techniques were used. Apart from 4 episodes of intraoperative hyperthermia and postoperative tachycardia, no complications were noted. These episodes may be similar to the nonmalignant hyperthermia reported in osteogenesis imperfecta and Costello syndrome patients. CONCLUSIONS: While the safety of any anesthetic technique cannot be established or extrapolated from a small series, given the extreme rarity of the syndrome, these cases suggest the relative safety of anesthesia in de Barsy syndrome patients.