Key result
Anesthetic management using volatile agents or propofol was safe in 22 pediatric patients undergoing left cardiac sympathetic denervation, with 0% experiencing perioperative cardiac events.
Why the study?
Is anesthetic management using volatile agents or propofol, along with beta-blockers and lidocaine, safe in pediatric patients undergoing left cardiac sympathetic denervation for LQTS and CPVT?
Observational (n=22)
Is anesthetic management using volatile agents or propofol, along with beta-blockers and lidocaine, safe in pediatric patients undergoing left cardiac sympathetic denervation for LQTS and CPVT?
Anesthetic management using volatile agents or propofol, supplemented with beta-blockers and lidocaine, appears safe in pediatric patients undergoing left cardiac sympathetic denervation for LQTS and CPVT.
OBJECTIVE: To describe our experience in the anesthetic management of pediatric patients who have undergone left cardiac sympathetic denervation (LCSD) for congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). BACKGROUND: Long QT syndrome and CPVT predispose patients to ventricular arrhythmias and sudden death. One treatment option for these patients is LCSD. When these patients present for LCSD or other surgical procedures, anesthetic management is challenging, as many medications may exacerbate QT prolongation. METHODS: Retrospective review of the electronic medical records of 22 pediatric patients who underwent LCSD between November 2005 and December 2008. RESULTS: Six patients (27%) received midazolam as a premedication. Eleven patients (50%) underwent inhalation induction with sevoflurane. Eighty-six percentage received either sevoflurane or isoflurane for maintenance of anesthesia, while the remaining 14% received a propofol infusion. Nine patients (41%) received esmolol infusions intraoperatively, while one patient (4.5%) received a labetalol infusion. Three patients (14%) received lidocaine infusions. no significant cardiac or other events occurred in any of these patients in the perioperative period. CONCLUSIONS: Important anesthetic considerations in this population include avoidance of sympathetic stimulation, correction of any abnormal electrolytes, and the immediate availability of a defibrillator and magnesium sulfate to treat arrhythmias. Anxious patients may benefit from premedication to reduce sympathetic tone. We have safely used both volatile agents and propofol for induction and maintenance of anesthesia. In our experience, intraoperative infusions of beta-blockers and lidocaine seem to be helpful in reducing arrhythmogenic potential, especially in patients with profound QT prolongation.
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Kenyon et al. (2010) conducted an observational in Congenital long QT syndrome and catecholaminergic polymorphic ventricular tachycardia (n=22). Anesthetic management was evaluated on Significant cardiac or other events in the perioperative period. Anesthetic management using volatile agents or propofol was safe in 22 pediatric patients undergoing left cardiac sympathetic denervation, with 0% experiencing perioperative cardiac events.
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