Yuasa Haruyuki, Kitaura Atsuhiro, Kitayama Chiyako, Fuyuta Masaki, Mino Takashi, Okamoto Ken, Nakao Shinichi
Department of Anesthesiology, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan.
Department of Anesthesiology, Kindai University Faculity of Medicine, Osakasayama, Osaka, Japan.
Am J Case Rep. 2021 Mar 19;22:e927756. doi: 10.12659/AJCR.927756.
BACKGROUND Brugada syndrome is a potentially fatal cardiac arrhythmia characterized by incomplete right bundle-branch block (RBB) and characteristic ST-segment elevation in the anterior electrocardiogram (ECG) leads. This report is of a case of type 2 Brugada syndrome, and discusses the importance of preoperative history and ECG evaluation. CASE REPORT A 32-year-old man was scheduled for tympanoplasty. His preoperative ECG revealed saddleback-type J waves in V₂ (>2 mm) and ST increase (>1 mm) detected 1 week before elective surgery, but the ECG 1 year before showed normal. He had no notable past history. Anesthesia was induced with remifentanil and propofol, and maintained with sevoflurane in combination with remifentanil. Routine monitoring of vital signs was supplemented with V2 monitoring on the ECG. The heart rate was maintained at above 60 beats/min using ephedrine. The course of the operation was uneventful. CONCLUSIONS We managed anesthesia for a patient with a type 2 Brugada syndrome ECG without events, probably because he had no notable past history such as syncope. Type 2 and type 3 Brugada syndrome ECGs are difficult to recognize, and patients with them are considered to be less risky than a patient with a type I ECG. However, as Brugada syndrome ECG is dynamic and changeable, a type 2 or 3 Brugada syndrome ECG can change to a type I ECG under some conditions, and thus should not be overlooked, and the patient's past history or symptoms, such as syncope, should be carefully investigated.
Brugada综合征是一种潜在致命性心律失常，其特征为不完全性右束支传导阻滞（RBB）以及心电图（ECG）前壁导联特征性ST段抬高。本报告为1例2型Brugada综合征病例，并探讨术前病史及心电图评估的重要性。病例报告：一名32岁男性计划行鼓室成形术。其术前心电图显示在V₂导联有鞍背型J波（>2mm），且在择期手术前1周检测到ST段抬高（>1mm），但1年前的心电图显示正常。他既往无明显病史。采用瑞芬太尼和丙泊酚诱导麻醉，并用七氟醚联合瑞芬太尼维持麻醉。在常规监测生命体征的基础上，补充V₂导联心电图监测。使用麻黄碱将心率维持在60次/分钟以上。手术过程顺利。结论：我们对1例2型Brugada综合征心电图患者进行麻醉管理，未发生意外情况，可能是因为他既往无晕厥等明显病史。2型和3型Brugada综合征心电图难以识别，且认为此类患者比1型心电图患者风险更低。然而，由于Brugada综合征心电图具有动态变化性，2型或3型Brugada综合征心电图在某些情况下可转变为1型心电图，因此不应被忽视，且应仔细调查患者的既往病史或症状，如晕厥。
