Background and Aims Brugada syndrome (BrS) is a channelopathy, with electrocardiographic changes predisposing to malignant ventricular arrhythmias and sudden cardiac death. Since several drugs used in common anesthetic practice interact with cardiac ion channels like local anesthetics, BrS is a clinical condition that requires adequate anesthetic planning. Epidural analgesia (EA) is historically considered a relative contraindication due to the possibility of arrhythmias although supporting evidence is lacking.
Methods A 31-year-old multipara with type 1 BrS diagnosed after syncope and episodes of ventricular tachycardia with an implantable cardioverter defibrillator under quinidine, presented to the Emergency department in labour. After fully informed about the risks an epidural catheter (EC) was placed, under continuous ECG, pulse oximetry, temperature, and blood pressure monitoring. A test dose of 5 mL ropivacaine 0.2% with sufentanil 1 ug/mL was administered resulting in no hemodynamic changes. After 10 minutes a loading dose of 9 mL of the same mixture was given with no changes. The analgesia consisted in ropivacaine 0.1% boluses hourly.
Results During the entire labor, she was hemodynamically stable under adequate monitoring, with controlled pain. The evolution was to an uneventful eutocic delivery within 4 hours.
Conclusions EA is an excellent choice for labour, with adequate pain control, without significant hemodynamic changes and maintenance the parturient’s collaboration in childbirth. In patients with BrS, ropivacaine is presumably safer than bupivacaine because it dissociates from the cardiac sodium channel more rapidly. We found that EA with ropivacaine is a safe and effective in patients with BrS if adequate monitoring is assured during labour.
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