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Review
. 2023 Jul-Sep;17(3):394-400.
doi: 10.4103/sja.sja_205_23. Epub 2023 Jun 22.

Anesthesiological management of Brugada syndrome patients: A systematic review

Giuseppe Cuttone  1 , Gennaro Martucci  2 , Ruggero Napoli  1 , Stefano Tigano  3 , Antonio Arcadipane  2 , Federico Pappalardo  4 , Filippo Sanfilippo  3
Affiliations
Review

Anesthesiological management of Brugada syndrome patients: A systematic review

Giuseppe Cuttone et al. Saudi J Anaesth. 2023 Jul-Sep.

Abstract

Brugada syndrome (BrS) is a major risk factor for sudden cardiac death and ventricular tachyarrhythmias. Several drugs are contraindicated in patients with BrS, including some commonly administered drugs during anesthesia or in the perioperative period; however, there is still a paucity of evidence regarding BrS and common anesthetic pharmaceuticals. We conducted a systematic literature search (PubMed, updated October 10, 2022), including all studies reporting pharmacological management of BrS patients during anesthesia or intensive care, with a specific focus on proarrhythmic effects and possible pharmacological interactions in the context of BrS. The search revealed 44 relevant items, though only three original studies. Two randomized controlled studies were identified, one comparing propofol and etomidate for the induction of general anesthesia and one investigating lidocaine with or without epinephrine for local anesthesia; there was also one prospective study without a control group. The other studies were case series (n = 5, for a total of 19 patients) or case reports (n = 36). Data are reported on a total population of 199 patients who underwent general or local anesthesia. None of the studies evaluated BrS patients in the intensive care unit (ICU). We found the studies focusing on the pharmacological management of BrS patients undergoing general or local anesthesia to be of generally poor quality. However, it appears that propofol can be used safely, without an increase in arrhythmic events. Regional anesthesia is possible, and lidocaine might be preferred over longer-acting local anesthetics. Considering the quality of the included studies and their anecdotal evidence, it seems increasingly important to conduct large multicenter studies or promote international registries with high-quality data on the anesthesiological management of these patients.

Keywords: Anesthesiology; Brugada syndrome; arrhythmia; critical care; propofol; tachycardia.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
ECG types of BrS. Copyright © 2006 Napolitano and Priori; licensee BioMed Central Ltd
Figure 2
Figure 2
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of study screening and selection
See this image and copyright information in PMC

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