Ventricular tachycardia during general anesthesia in a patient with congenital long QT syndrome

Congenital long QT syndrome is characterized by a corrected QT interval of at least 440 msec on the electrocardiogram and has been associated with recurrent syncope, documented ventricular arrhythmia and sudden death. There have been numerous articles over the past 20 years describing isolated insta...

Full description

Saved in:

Bibliographic Details
Published in:	Canadian journal of anesthesia Vol. 50; no. 4; pp. 398 - 403
Main Authors:	KATZ, Robert I, QUIJANO, Irene, BARCELON, Nelson, BIANCANIELLO, Thomas
Format:	Journal Article
Language:	English
Published:	Toronto, ON Canadian Anesthesiologists' Society 01-04-2003 Springer Nature B.V
Subjects:	Anesthesia Anesthesia, General - adverse effects Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Inhalation - adverse effects Biological and medical sciences Cardiac arrhythmia Child Electrocardiography Female General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation Halothane - adverse effects Humans Long QT syndrome Long QT Syndrome - complications Long QT Syndrome - congenital Medical sciences Nitrous Oxide - adverse effects Tachycardia, Ventricular - etiology Human Wave burst Arrhythmia Congenital Prolonged QT interval Cardiovascular disease General anesthesia Conduction disorder Excitability disorder Case study Heart block Heart disease Complication Paroxysmal ventricular tachycardia Child
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Congenital long QT syndrome is characterized by a corrected QT interval of at least 440 msec on the electrocardiogram and has been associated with recurrent syncope, documented ventricular arrhythmia and sudden death. There have been numerous articles over the past 20 years describing isolated instances of surgical and anesthesia related complications but the general anesthetic management of the condition remains unclear. An 11-yr-old female with documented long QT syndrome, with two episodes of syncope in the past, was admitted for emergency drainage of left periorbital cellulitis. Anesthesia was induced with propofol, fentanyl and rocuronium, and initially maintained with nitrous oxide and halothane. After 20 min, the patient developed ventricular tachycardia (torsade de pointes). Lidocaine 1 mg.kg(-1) iv was given and the rhythm reverted to normal sinus. Halothane was discontinued and the surgery proceeded without further incident. Our review of the literature revealed that patients with long QT syndrome whose symptoms are well controlled prior to surgery tend to do well regardless of the anesthetic chosen. There are, however, theoretical reasons to avoid anesthetics which either sensitize the myocardium to catecholamines or which cause an increase in circulating levels of catecholamines.
ISSN:	0832-610X 1496-8975
DOI:	10.1007/BF03021039