Perioperative management of patients with pre-excitation syndromes
Chryssoula Staikou1, Mattheos Stamelos1, Eftyhios Stavroulakis2
1 Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
2 Department of Anaesthesiology, 401 Military Hospital, Athens, Greece
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil , alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely.
Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic
blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other preexcitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown- Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
Keywords: Pre-excitation; Wolff-Parkinson-White syndrome; Mahaim fiber syndrome; Lown-Ganong- Levine syndrome; anaesthesia