title: Successful management of cesarean section in a patient with Romano-Ward syndrome using landiolol, a selective and short-acting beta1 receptor antagonist.
abstract: Romano-Ward (R-W) syndrome is an autosomal dominant hereditary disorder and is characterized by a prolonged QT interval on the electrocardiogram (ECG), syncope, and sudden death. We report here a case of cesarian section in a patient with R-W syndrome whose QT prolongation was successfully managed with landiolol, a selective beta1 receptor blocker. A 25-year-old woman with R-W syndrome was scheduled for cesarean section. In the operating room, the patient's ECG showed tachycardia (102 beats x min(-1)) and marked QT prolongation (QTc = 0.56 s). After spinal anesthesia, the patient's heart rate (HR) increased to 130 beats/min accompanied by a slight decrease in arterial blood pressure to 97/57 mmHg and the QTc was prolonged to 0.57 s. Landiolol was continuously infused at a rate of 0.04 mg.kg(-1) x min(-1) and the HR gradually decreased to 80-90 beats x min(-1) accompanied by the normalization of QTc to 0.48 s. We thought that the use of landiolol was more rational and was preferable to a nonselective beta receptor blocker for a term-pregnant woman because blockade of the beta2 receptor might cause uterine contraction. After the use of landiolol, intraoperative and postoperative courses in both the patient and the baby were uneventful.
authors.affiliation: Department of Anesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi 570-8507, Japan.
authors.forename: Kozue
authors.initials: K
authors.lastname: Kubo
authors.forename: Kohei
authors.initials: K
authors.lastname: Murao
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakao
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kanoda
authors.forename: Makiko
authors.initials: M
authors.lastname: Yamada
authors.forename: Koh
authors.initials: K
authors.lastname: Shingu
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D002585:Cesarean Section; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy* / Q000503:physiopathology; D029597:Romano-Ward Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D014508:Urea / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D009025:Morpholines; C077049:landiolol; D014508:Urea