Περίληψη:
Patients with inherited cardiac channel disorders are at high risk of perioperative lethal arrhythmias. Preoperative control of symptoms and a multidisciplinary approach are required for a well-planned management. Good haemodynamic monitoring, adequate anaesthesia and analgesia, perioperative maintenance of normocarbia, normothermia, and normovolaemia are important. In congenital long QT syndrome, torsades de pointes should be prevented with magnesium sulphate infusion and avoidance of drugs such as droperidol, succinylcholine, ketamine, and ondansetron. Propofol and epidural anaesthesia represent safe choices, while caution is needed with volatile agents. In Brugada syndrome, β-blockers, α-agonists, and cholinergic drugs should be avoided, while isoproterenol reverses the ECG changes. Propofol, thiopental, and volatiles have been used uneventfully. In congenital sick sinus syndrome, severe bradycardia resistant to atropine may require isoproterenol or epinephrine. Anaesthetics with vagolytic properties are preferable, while propofol and vecuronium should be given with caution due to risk of inducing bradyarrhythmias. Neuraxial anaesthesia should produce the least autonomic imbalance. Arrhythmogenic right ventricular dysplasia/cardiomyopathy induces ventricular tachyarrhythmias, which should be treated with β-blockers. Generally, β-adrenergic stimulation and catecholamine release should be avoided. Halothane and pancuronium are contraindicated, while large doses of local anaesthetics and epinephrine should be avoided in neuraxial blocks. In catecholaminergic polymorphic ventricular tachycardia, β-blocker treatment should be continued perioperatively. Catecholamine release and β-agonists, such as isoproterenol, should be avoided. Propofol and remifentanil are probably safe, while halothane and pancuronium are contraindicated. Regional anaesthesia, without epinephrine, is relatively safe. In suspicious cardiac deaths, postmortem examination and familial screening are recommended. © The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
Συγγραφείς:
Staikou, C.
Chondrogiannis, K.
Mani, A.
Λέξεις-κλειδιά:
adrenalin; alfentanil; atropine; beta adrenergic receptor blocking agent; bupivacaine; diamorphine; esmolol; etilefrine; fentanyl; glycopyrronium bromide; isoflurane; isoprenaline; landiolol; levobupivacaine; lidocaine; magnesium sulfate; metaraminol; midazolam; morphine; nitrous oxide; ondansetron; propofol; remifentanil; rocuronium; sevoflurane; sodium channel blocking agent; suxamethonium; thiopental; unindexed drug; vecuronium, autopsy; blood volume; body temperature; bradycardia; Brugada syndrome; cardiac channelopathy; defibrillation; defibrillator; drug contraindication; drug safety; electrocardiogram; epidural anesthesia; general anesthesia; genotype; heart arrhythmia; heart death; heart pacing; heart right ventricle dysplasia; heart ventricle extrasystole; heart ventricle fibrillation; heart ventricle tachycardia; hemodynamic monitoring; hereditary arrhythmogenic syndrome; human; long QT syndrome; obstetric analgesia; perioperative period; polymorphic ventricular tachycardia; preoperative treatment; priority journal; QT interval; QT prolongation; regional anesthesia; resuscitation; review; sick sinus syndrome; sudden death; torsade des pointes
