Spinal travmanın eşlik ettiği Wolf Parkinson White Sendrom’lu hastaların anestezi yönetimi

Öz

Wolff-Parkinson-White sendromu nadir görülen, patolojik aksesuar yolak olan Kent demetinden kaynaklanan iletinin ventriküle ulaştığı preeksitasyon sendromudur. Çoğu preeksitasyon sendromlu hastalar olumsuz bir klinik sunuma sahip olmasalar da hafif ve orta derecede göğüs ağrısından ciddi kardiyopulmoner rahatsızlıklara kadar değişen hatta ani kardiyak ölümle sonuçlanan bulgulara sahip olabilirler. Anestezik ilaçlar ve anestezi uygulama yöntemleri atriyoventriküler (AV) nodun iletiminde değişikliklere neden olarak taşiaritmi riskinde artışa neden olabilir. Wolff-Parkinson-White sendromlu hastaların anestezi yönetimleriyle ilgili olarak literatürde olgu sunumları yer almasına rağmen genel anestezi verilen hastalarda sugammadeks kullanımıyla ilgili bir olgu sunumu literatürde yer almamaktadır. Wolff-Parkinson-White tanısı almış, elektrokardiyografisinde delta dalgası ve kısa PR intervali bulunan, 28 yaşında, 75 kg erkek hasta 3 yıl önce geçirdiği araç içi trafik kazası sonrası spinal travmaya bağlı gelişen bilateral bacaklarda spastisite nedeniyle baklofen pompası takılması amacıyla ameliyathaneye kabul edildi. Sorunsuz bir cerrahi sonrasında hastaya nöromüsküler bloker olarak verdiğimiz rokuronyumun etkisinin geri döndürülmesinde bu hastalar için fatal aritmi potansiyeli bulunan neostigmin ve atropin kombinasyonu yerine sugammadeks verildi. Anestezi yönetiminin başarılı olduğu bu hasta komplikasyon gelişmeden servise devredildi. Genel anestezi altında cerrahi uygulanacak olan Wolff-Parkinson-White sendromlu hastaların anestezi yönetiminde sugamadeks kullanımının daha güvenli olacağı kanısına varılmıştır.

Anahtar Kelimeler

• Spinal travma, preeksitasyon, anestezi yönetimi

Anesthesia Management in a Patient with Spinal Trauma and Wolff-Parkinson White-Syndrome

Abstract

Wolff-Parkinson-White syndrome is a rare ventricular pre-excitation syndrome which is caused by a pathological accessory pathway, Kent bundle. Although patients with pre-excitation syndrome may not have a negative clinical presentation, various symptoms arising from mild-moderate chest pain to serious cardiopulmonary dysfunction even sudden cardiac death may occur. Anesthetic drugs and methods tend to change the physiology of atrioventricular node conduction, hence causing an increase in risk of tachyarrhythmia. Despite the case reports in literature about anesthetic management of patients with Wolff-Parkinson-White syndrome, the use of sugammadex was not reported before. The patient was 28-year-old, 75 kg, diagnosed with Wolff-Parkinson-White syndrome and scheluded for elective insertion of baclofen pump due to bilateral leg spasticity, three year after spinal trauma because of a car accident. His electrocardiography showed shortened PR interval and delta waves. After an uneventful surgery, sugammadex was administered as a reversal agent of rocuronium bromide instead of neostigmine and atropine that may cause potentially fatal arrhythmias for these patients. This patient was discharged to his service after a successful anesthetic management without complications. We concluded that surgical procedures under general anesthesia for patients with Wolff-Parkinson-White syndrome may be safer with the use of sugammadex for anesthetic management.

Keywords

• spinal trauma, preexcitation, anesthesia management

References

1. 1. Koneru JN, Wood MA, Ellenbogen KA. Rare forms of preexcitation: a case study and brief overview of familial forms of preexcitation. Circ Arrhythm Electrophysiol 2012;5:e82-87.
2. 2. Wakita R, Takahashi M, Ohe C, Kohase H, Umino M. Occurrence of intermittent Wolff-Parkinson-White syndrome during intravenous sedation. J Clin Anesth 2008;20:146- 149.
3. 3. Kabade SD, Sheikh S, Periyadka B. Anaesthetic management of a case of Wolff-Parkinson-White syndrome. Indian J Anaesth 2011;55:381-383.
4. 4. Pauriah M, Cismaru G, Sellal JM, De Chillou C, BrembillaPerrot B. Is isoproterenol really required during electrophysiological study in patients with Wolff-ParkinsonWhite syndrome? Journal of Electrocardiology 2013;46:686- 692.
5. 5. Sahu S, Karna ST, Karna A, Lata I, Kapoor D. Anaesthetic management of Wolff-Parkinson-White syndrome for hysterectomy. Indian J Anaesth 2011;55:378-380.
6. 6. Sinha PK, Kumar B, Varma PK. Anesthetic management for surgical repair of Ebstein's anomaly along with coexistent Wolff-Parkinson-White syndrome in a patient with severe mitral stenosis. Ann Card Anaesth 2010;13:154-158.
7. 7. Nehgme R. “Evaluation and treatment of other arrhythmic causes of syncope in children and adolescents with an apparently normal heart Wolff-Parkinson-White syndrome and right ventricular cardiomyopathy” Progress in Pediatric Cardiology. 2001;13:111-125.
8. 8. Naço M, Çeliku E, Llukaçaj A, Shehaj J, Kameniku R. Toxic adenoma of the thyroid gland and Wolff-Parkinson-White syndrome. Hippokratia 2009;13:116-118.

9. 9. Teixeira VC, Neves MA, Castro RA. Latex allergy in a patient with Kabuki syndrome. Case report. Rev Bras Anestesiol 2010;60:5:544-550.
10. 10. Lustik SJ, Wojtczak J, Chhibber AK. Wolff-Parkinson-White syndrome simulating inferior myocardial infarction in a cocaine abuser for urgent dilation and evacuation of the uterus. Anesth Analg 1999;89:609-612.
11. 11. Robinson JE, Morin VI, Douglas MJ, Wilson RD. Familial hypokalemic periodic paralysis and Wolff-Parkinson-White syndrome in pregnancy. Can J Anaesth 2000;47:160-164.
12. 12. Kadoya T, Seto A, Aoyama K, Takenaka I. Development of rapid atrial fibrillation with a wide QRS complex after neostigmine in a patient with intermittent Wolff-ParkinsonWhite syndrome. Br J Anaesth 1999;83:815-818.
13. 13. Misa VS, Pan PH. Evidence-based case report for analgesic and anesthetic management of a parturient with Ebstein’s Anomaly and Wolff-Parkinson-White syndrome. Int J Obstet Anesth 2007;16:77-81.
14. 14. Fujii K, Iranami H, Nakamura Y, Hatano Y. Fentanyl added to propofol anesthesia elongates sinus node recovery time in pediatric patients with paroxysmal supraventricular tachycardia. Anesth Analg 2009;108:456-460.
15. 15. Seki S, Ichimiya T, Tsuchida H, Namiki A. A Case of Normalization of Wolff-Parkinson-White Sydrome Conduction during Propofol Anesthesia. Anesthesiology 1999;90:1779-1881.
16. 16. Sharpe MD, Dobkowski WB, Murkin JM, Klein G, Yee R. Propofol has no direct effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolff-Parkinson-White syndrome during alfentanil/midazolam anesthesia. Anesthesiology 1995;82:888-895.
17. 17. Chambers D, Paulden M, Paton F. et al. Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment. Br J Anaesth 2010;105:568-575..