%0 Journal Article
%T A Novel Anaesthetical Approach to Patients with Brugada Syndrome in Neurosurgery
%A Pietro Paolo Martorano
%A Edoardo Barboni
%A Giovanni Buscema
%A Alessandro Di Rienzo
%J Case Reports in Anesthesiology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/280826
%X Brugada syndrome (BrS) is one of the most common causes of sudden death in young people. It usually presents with life-threatening arrhythmias in subjects without remarkable medical history. The need for surgical treatment may unmask BrS in otherwise asymptomatic patients. The best anaesthesiological treatment in such cases is matter of debate. We report a case of neurosurgical treatment of cerebello pontine angle (CPA) tumor in a BrS patient, performed under total intravenous anesthesia (TIVA) with target controlled infusion (TCI) modalities, using midazolam plus remifentanil and rocuronium, without recordings of intraoperative ECG alterations in the intraoperative period and postoperative complications. 1. Introduction BrS is a rare dominant autosomal disease with incomplete penetrance, first described in 1992 by P. Brugada and J. Brugada [1]. More common in men than in women, it is typically diagnosed during the fourth decade of life, and it is caused by a genetic mutation affecting the ion channels of the cardiac conduction system. The typical clinical correlate is a coved ST segment elevation in the right precordial leads that can occur with or without an incomplete right bundle branch block. Owing to its phenotypic variability, clinical manifestations of BrS are protean, including syncope or spontaneous ventricular arrhythmias that can lead to a sudden death [2, 3], which all may be elicited in such peculiar situations (vagal tone increase, fever, and electrolytes disorder) or by peculiar drugs administration including some anaesthetics [4]. There is still no consense on which the golden standard should be in case of general anaesthesia in these cases, especially because of the low prevalence of BrS, the absence of large prospective study, and the different anaesthesiological needs according to different surgical specialties. Existing guidelines derives from theoretical model based on the pathophysiological mechanism of BrS and from case series regarding a small number of patients. As regards the use of intravenous anesthetics in patients with BrS, propofol, and midazolam wase successfully used in different procedures [5, 6]. Propofol is a short acting, intravenous hypnotic, that ensures fast onset and rapid recovery of anesthesia, reducing PONV (postoperative nausea and vomiting). It represents the hypnotic of choice for TIVA/TCI use in neurosurgery, due to his low impact on CBF and the ability to mantain cerebral autoregulation, however, allowing a rapid recovery of the cognitive function at the end of the procedure. The recommendation to avoid
%U http://www.hindawi.com/journals/cria/2013/280826/