title: Safe single-dose administration of propofol in patients with established Brugada syndrome: a retrospective database analysis.
abstract: BACKGROUND
  Propofol is an anesthetic drug with a very attractive pharmacokinetic profile, which makes it the induction agent of choice, especially in day-case surgery. Data on its potential proarrhythmic effects in patients with Brugada syndrome (BS) patients are still lacking. The aim of our study was to investigate whether a single dose of propofol triggered any adverse events in consecutive high-risk patients with BS.
  
  
  METHODS
  All consecutive patients with BS having undergone an implantable cardiac defibrillator implantation under general anesthesia were eligible for this study. The anesthetic chart of each patient was reviewed, and the occurrence of malignant arrhythmic events as well as the need for defibrillation during induction and maintenance of anesthesia was investigated. Further monitoring of the patient comprised five-lead electrocardiogram (ECG), pulse oxymetry, and continuous carbon dioxide monitoring through side sampling from the ventilator tubes. Anesthesia was induced with propofol and sufentanyl. Injection of propofol occurred in a single-shot bolus-as often performed by most anesthetists-over a few seconds. Anesthesia was maintained with volatile anesthetics (sevoflurane or desflurane) in an oxygen-air mixture.
  
  
  RESULTS
  From 1996 to 2011, 57 high-risk patients with BS (35 males; mean age: 43 ± 16 years) underwent an automated implantable cardioverter defibrillator implantation at our center using propofol as induction drug of general anesthesia. Three patients had a history of spontaneous type I ECG, three had aborted sudden death, and 51 had a history of recurrent or unexplained syncope. The induction dose ranged between 0.8 mg/kg and 5.0 mg/kg (2.2 ± 0.7 mg/kg). Only one case received propofol to maintain anesthesia. The surgical procedure involved an anesthetic period of 75 ± 25 minutes. No patient developed a malignant rhythm during induction and maintenance of anesthesia. All patients were then safely discharged from the postanesthetic care unit after 1 hour. No adverse events were noticed during the recovery phase. In our study, administration of a single-dose propofol in patients with BS was safe. Nevertheless, extreme caution is still recommended when conducting general anesthesia in patients with BS, especially if BS patients are sedated with propofol for longer periods.
authors: Department of Anaesthesiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium.
authors: Panagiotis
authors: P
authors: Flamée
authors: Carlo
authors: C
authors: De Asmundis
authors: Jigme T
authors: JT
authors: Bhutia
authors: Giulio
authors: G
authors: Conte
authors: Stefan
authors: S
authors: Beckers
authors: Vincent
authors: V
authors: Umbrain
authors: Christian
authors: C
authors: Verborgh
authors: Gian-Battista
authors: GB
authors: Chierchia
authors: Sophie
authors: S
authors: Van Malderen
authors: Rubén
authors: R
authors: Casado-Arroyo
authors: Andrea
authors: A
authors: Sarkozy
authors: Pedro
authors: P
authors: Brugada
authors: Jan
authors: J
authors: Poelaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D053840:Brugada Syndrome / Q000188:drug therapy*; D002648:Child; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Brugada syndrome; general anesthesia; propofol