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Brugada综合征:一名偶然诊断患者的麻醉相关问题

Brugada Syndrome: Anesthetic Implications in an Incidentally Diagnosed Patient.

作者信息

Domingues Catia, Gonçalves Luís, Alves Rita, Mafra Andreia, Gonçalves Lucia

机构信息

Anesthesiology, Unidade Local de Saúde da Região de Leiria, Leiria, PRT.

出版信息

Cureus. 2024 Aug 15;16(8):e66963. doi: 10.7759/cureus.66963. eCollection 2024 Aug.

Abstract

Brugada syndrome (BS) is characterized by abnormal repolarization in cardiac cells, occurring in the absence of structural heart disease, which elevates the risk of ventricular arrhythmias and sudden cardiac death. While most BS patients are asymptomatic, a notable percentage experience syncope or sudden cardiac death. Diagnosis is primarily based on electrocardiographic (ECG) findings. A 40-year-old male with a history of syncope and a family history of sudden cardiac death was scheduled for urgent clavicle osteosynthesis. Preoperative ECG revealed type 1 BS. A multidisciplinary approach was taken, and anesthetic management involved combined general and regional anesthesia, utilizing ultrasound-guided clavipectoral and superficial cervical blocks. Postoperative pain was managed with paracetamol and ketorolac. The patient remained stable throughout the procedure, was monitored for 36 hours postoperatively, and was discharged without complications. BS poses significant perioperative risks, necessitating careful anesthetic management. This case report highlights the successful use of combined general and regional anesthesia in a BS patient, contributing to the limited evidence on safe anesthesia practices for this pathology.

摘要

Brugada综合征(BS)的特征是心脏细胞复极化异常,在无结构性心脏病的情况下发生,这会增加室性心律失常和心源性猝死的风险。虽然大多数BS患者无症状,但有相当比例的患者会出现晕厥或心源性猝死。诊断主要基于心电图(ECG)表现。一名有晕厥病史且有家族心源性猝死史的40岁男性计划进行紧急锁骨骨折内固定术。术前心电图显示为1型BS。采取了多学科方法,麻醉管理采用全身麻醉和区域麻醉相结合,利用超声引导锁骨胸肌和颈浅阻滞。术后疼痛用对乙酰氨基酚和酮咯酸进行处理。患者在整个手术过程中保持稳定,术后监测36小时,出院时无并发症。BS带来重大的围手术期风险,需要仔细的麻醉管理。本病例报告强调了在BS患者中成功使用全身麻醉和区域麻醉相结合的方法,为关于这种病理状况的安全麻醉实践的有限证据做出了贡献。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cf4e/11401650/feef36c7317d/cureus-0016-00000066963-i01.jpg

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