Anesthesia Considerations 

Brugada Syndrome 

 

 

Background 

 

• Brugada syndrome is a rare autosomal dominant disease & is associated with sudden cardiac death from ventricular fibrillation or tachycardia (VT/VF), especially in Southeast Asian males 

 

 

Anesthetic Considerations 

 

• Potential for hemodynamic collapse due to VT & VF

• Avoid exacerbating factors of Brugada (ST Elevation):

  • Parasympathetic nervous system stimulation (increase in vagal tone)

  • Medications

    • Avoid BB, alpha agonists, neostigmine

    • Avoid class Ia antiarrhythmic (procainamide)

  • Electrolyte abnormalities: ↑↓K, ↑Ca

  • Fever 

• Considerations of AICD if in situ (only known treatment) 

• Preparations for treating Brugada Exacerbations or cardiac arrest:

  • All patients without AICD need defibrillator & pads in OR

  • Atropine, Ephedrine, Isoproterenol 

• Resuscitation drugs should be available

 

 

Typical ECG findings

• Characteristic findings are RBBB & ST elevation in V1-V3