Smooth Emergence from General Anesthesia after Deep Extubation in a Pediatric Patient Diagnosed with Catecholaminergic Polymorphic Ventricular Tachycardia: A Case Report

• Published in: Medicina (Kaunas, Lithuania) Vol. 59; no. 12; p. 2067
• Main Authors: Cho, Seung Bae, Choi, Beomseok, Ki, Seunghee, Hwang, Seokwoo, Oh, Juseok, Jung, Insik, Lee, Jeonghan
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-11-2023
• Subjects: Airway management; Analgesics; anesthetic management; Anxiety; arrhythmia; Beta blockers; Bupivacaine; Cardiac arrhythmia; Cardiac patients; Case reports; catecholaminergic polymorphic ventricular tachycardia; Catecholamines; Catheters; Children; Consciousness; Dexmedetomidine; Electrocardiography; endotracheal extubation; Exercise; Extubation; Fainting; Gas flow; General anesthesia; Genetic disorders; Health aspects; intraoperative monitoring; Intubation; Oxygen saturation; Patients; Pediatric anesthesia; Pediatrics; Physical fitness; postoperative nausea and vomiting; Remifentanil; Strabismus; Stress; Surgery; Ventricular tachycardia; Vital signs; intraoperative monitoring; anesthetic management; catecholaminergic polymorphic ventricular tachycardia; arrhythmia; endotracheal extubation; postoperative nausea and vomiting
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina59122067

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare genetic disorder where catecholamine causes bidirectional ventricular tachycardia, potentially leading to cardiac arrest. In patients undergoing surgery, sympathetic responses can be triggered in situations associated with surgical stimulations as well as high anxiety before the surgery, anesthetic maneuvers such as endotracheal intubation and extubation, and postoperative pain. Therefore, planning for surgery demands meticulous attention to anesthesia during the perioperative period in order to prevent potentially life-threatening arrhythmias.
We discuss a case of an 11-year-old male pediatric patient with known CPVT who required elective strabismus surgery for exotropia involving both eyes. After thorough planning of general anesthesia to minimize catecholamine response, sufficient anesthesia and analgesia were achieved to blunt the stressful response during intubation and maintained throughout the surgical procedure. Complete emergence was achieved after deep extubation, and the patient did not complain of pain or postoperative nausea and vomiting.
Anesthesiologists should not only be able to plan and manage the catecholamine response during surgery but also anticipate and be prepared for situations that may lead to arrhythmias before and after the procedure. In certain cases, deep extubation can be beneficial as it reduces hemodynamic changes during the extubation process.