Anaesthetic management of Wolff Parkinson White syndrome for caesarean section

We present two cases of WPW syndrome in pregnancy. Risk factors for development of supraventricular tachycardia and the anaesthetic management during caesarean section are discussed. We recommend that regional anaesthesia can be given in patients with WPW syndrome; Phenylephrine is the best vasopressor for treatment of hypotension during spinal blockage and Adenosine is the first line therapy for the acute termination of PSVT. In women of reproductive age, the commonest arrhythmia seen is paroxysmal supraventricular tachycardia (SVT).1 Wolf Parkinson White syndrome accounts for the majority of supraventricular tachycardia in this population; with an incidence of 1.2 per 1000 people. Over half of these patients are asymptomatic.2Patients may complain of palpitation, dizziness, syncope or shortness of breath. The diagnosis is confirmed by E.C.G. The incidence and severity of tachyarrhythmia in these patients may increase during pregnancy. Although reasons for this observation are unclear, some explanations have been proposed. Increased awareness, hemodynamic, hormonal, autonomic and emotional changes related to pregnancy, which may include increase in plasma catecholamine concentrations and adrenergic receptor sensitivity, atrial stretch and increased end diastolic volumes due to intravascular volume expansion have been implicated as some of the reasons.3 We present two cases of Wolf Parkinson White syndrome who underwent caesarean section under regional anaesthesia. A 28 year old female, primigravida, was planned for caesarean section for cephalopelvic disproportion. The patient gave history of palpitations occasionally before pregnancy. But her symptoms increased during pregnancy. The patient did not give any history of syncope, dizziness or chest pain. In preanaesthetic check up, ECG showed features of WPW syndrome. The patient was advised cardiological consultation who confirmed the diagnosis. She was not put on any medication except anxiolytics. She was planned for caesarean section under spinal anaesthesia. Her preoperative heart rate and blood pressure was normal. She was preloaded with 500 ml of normal saline. Routine monitoring included ECG, NIBP and pulse oximetry. Spinal anaesthesia was achieved with 2.5 ml hyperbaric Bupivacaine (12.5 mgs) using 25 G pencil point needle in sitting position. The patient was given a left lateral tilt of 15-20 degrees to prevent supine hypotensive syndrome. A live healthy baby was delivered. Soon after the delivery of the baby, syntocinon 5 units were given as bolus and an infusion of 15 units in 500 ml of normal saline commenced. At this moment patient complained of palpitations and dizziness. Her heart rate increased from 84 to 180 beats / min and her blood pressure dropped to 80 mm Hg. Initially vagal manoeuvres were tried but without any improvement. Injection Phenylephrine 10 μg iv bolus was given which was repeated to treat hypotension. Adenosine 6 mg iv push was given which terminated arrhythmia and sinus rhythm was restored. There were no further episodes of PSVT and post operative period was uneventful. She was discharged after four days and was advised to follow cardiology department. Anaesthetic management of Wolff Parkinson White syndrome for caesarean section