Anaesthetic management of a pregnant woman with Brugada syndrome undergoing Caesarean section: a case report

BACKGROUND: Brugada syndrome occurs typically without structural heart disease and is regarded as an autosomal dominant condition. It is linked to a range of cardiac symptoms as well as potentially fatal ventricular arrhythmias that can cause sudden cardiac death. The patient in this case demonstrated electrocardiographic features consistent with Brugada syndrome, which were unmasked as a diagnostic Type 1 coved ST-segment elevation pattern in the right precordial leads (V1-V3) following Ajmaline provocation testing. The patient also mentioned feeling a little weak and dizzy with a few episodes of palpitations during the entire course of pregnancy. At 37 weeks of gestation, the patient, a pregnant woman, was scheduled for an elective Caesarean section. CASE PRESENTATION: An elective Caesarean section was planned for 37 weeks of gestation for a 38-year-old pregnant woman for breech presentation who demonstrated Brugada syndrome, morbid obesity (BMI 41), type 2 diabetes mellitus, anaemia, and a history of laparoscopic myomectomy. Multidisciplinary planning was undertaken involving anesthesiology, cardiology, endocrinology, and obstetrics. The primary plan was spinal anaesthesia with general anaesthesia as a backup due to her heart risk. The administration of 200 µg of morphine and 12.5 mg of bupivacaine intrathecally went satisfactorily. After a stable intraoperative period, the patient was observed in a high-dependency unit until being moved to the maternity ward without any issues. CONCLUSION: For certain parturients with Brugada syndrome, spinal anaesthesia can be safely given through preoperative assessment, interdisciplinary collaboration, and close intraoperative and postoperative monitoring.