Flamée Panagiotis, Viaene Kea, Tosi Maurizio, Nogueira Carvalho Hugo, de Asmundis Carlo, Forget Patrice, Poelaert Jan
From the Department of Anesthesiology and Perioperative Medicine and.
Department of Heart Rhythm Management Center, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
Anesth Analg. 2021 Jun 1;132(6):1645-1653. doi: 10.1213/ANE.0000000000005540.
Propofol administration in patients with Brugada syndrome (BrS) is still a matter of debate. Despite lacking evidence for its feared arrhythmogenicity, up to date, expert cardiologists recommend avoiding propofol. The main aim of this study is to assess the occurrence of malignant arrhythmias or defibrillations in patients with BrS, during and 30 days after propofol administration. The secondary aim is to investigate the occurrence of adverse events during propofol administration and hospitalization, as the 30-day readmission and 30-day mortality rate.
We performed a retrospective cohort study on patients with BrS who received propofol anytime from January 1, 1996 to September 30, 2020. Anesthesia was induced by propofol in both groups. In the total intravenous anesthesia (TIVA) group, anesthesia was maintained by propofol, while in the BOLUS group, volatile anesthesia was provided. The individual anesthetic charts and the full electronic medical records up to 30 postprocedural days were scrutinized.
One hundred thirty-five BrS patients who underwent a total of 304 procedures were analyzed. The TIVA group included 27 patients for 33 procedures, and the BOLUS group included 108 patients for 271 procedures. In the TIVA group, the median time of propofol infusion was 60 minutes (interquartile range [IQR] = 30-180). The estimated plasma or effect-site concentration ranged between 1.0 and 6.0 µg·mL-1 for target-controlled infusion (TCI). The infusion rate for manually driven TIVA varied between 0.8 and 10.0 mg·kg-1·h-1. In the BOLUS group, the mean propofol dose per kilogram total body weight was 2.4 ± 0.9 mg·kg-1. No malignant arrhythmias or defibrillations were registered in both groups. The estimated 95% confidence interval (CI) of the risk for malignant arrhythmias in the BOLUS and TIVA groups was 0-0.011 and 0-0.091, respectively.
The analysis of 304 anesthetic procedures in BrS patients, who received propofol, either as a TIVA or as a bolus during induction of volatile-based anesthesia, revealed no evidence of malignant arrhythmias or defibrillations. The present data do not support an increased risk with propofol-based TIVA compared to propofol-induced volatile anesthesia. Prospective studies are needed to investigate the electrophysiologic effects of propofol in BrS patents.
布加综合征（BrS）患者使用丙泊酚仍然存在争议。尽管缺乏其致心律失常性的证据，但截至目前，心脏病专家仍建议避免使用丙泊酚。本研究的主要目的是评估BrS患者在丙泊酚给药期间及给药后30天内发生恶性心律失常或除颤的情况。次要目的是调查丙泊酚给药及住院期间不良事件的发生情况，如30天再入院率和30天死亡率。
我们对1996年1月1日至2020年9月30日期间任何时间接受丙泊酚治疗的BrS患者进行了一项回顾性队列研究。两组均采用丙泊酚诱导麻醉。在全静脉麻醉（TIVA）组中，麻醉维持使用丙泊酚，而在单次推注组中，采用挥发性麻醉。仔细审查了个体麻醉记录和术后30天内的完整电子病历。
分析了135例BrS患者，共进行了304例手术。TIVA组包括27例患者，进行了33例手术，单次推注组包括108例患者，进行了271例手术。在TIVA组中，丙泊酚输注的中位时间为60分钟（四分位间距[IQR]=30 - 180）。目标控制输注（TCI）时，估计血浆或效应室浓度在1.0至6.0μg·mL-1之间。手动驱动TIVA的输注速率在0.8至10.0mg·kg-1·h-1之间变化。在单次推注组中，每千克总体重的丙泊酚平均剂量为2.4±0.9mg·kg-1。两组均未记录到恶性心律失常或除颤。单次推注组和TIVA组恶性心律失常风险的估计95%置信区间（CI）分别为0 - 0.011和0 - 0.091。
对接受丙泊酚治疗的BrS患者进行的304例麻醉手术分析显示，无论是作为TIVA还是在挥发性麻醉诱导时作为单次推注，均未发现恶性心律失常或除颤的证据。目前的数据不支持与丙泊酚诱导的挥发性麻醉相比，基于丙泊酚的TIVA风险增加。需要进行前瞻性研究来调查丙泊酚对BrS患者的电生理影响。
