Abstract
Pre-excitation disorders have an estimated prevalence of 0.15 per cent. Advances in electrophysiological mapping and the increasing sophistication of surgical techniques have resulted in an increasing role for definitive surgical treatment. A retrospective chart review of 181 patients undergoing 197 procedures for surgical ablation of accessory atrioventricular pathways between June 1981 to June 1986 was performed. Mean age of the patients was 30 years (range 6–66) with a preponderance of males (59 per cent). Associated cardiac disease was found in 18 (9.9 per cent) patients. Induction of anaesthesia employed either a barbiturate-relaxant (83 per cent) or a narcotic-benzodiazepinerelaxant (17 per cent) and was uneventful in all cases. In 14 per cent of cases a pure narcotic relaxant technique was employed for maintenance of anaesthesia, whereas a balanced technique with isoflurane (29 per cent), enflurane (34 per cent), or halothane (22 per cent) was utilized for the remainder. Muscle relaxation was provided by d-tubocurarine in 35 (18 per cent) procedures and pancuronium in the remaining 162 (82 per cent) procedures. There was no significant correlation between intraoperative arrhythmias and type of anaesthetic used. Although recognizing the potential for malignant arrhythmias, our experience (within the confines of a retrospective analysis) suggests that the majority of these patients can be managed successfully using standard anaesthetic techniques.
Résumé
Les syndromes de pré-excitation ont une prévalence estimée à 0.15 pour cent. Les progrès en cartographie ou mapping électrophysiologique et la sophistication accrue des techniques chirurgicales ont amené une augmentation croissante dans le traitement chirurgical définitif de ces syndromes. Une étude rétrospective a évalué 181 patients subissant 197 procédures pour ablation chirurgicale ďune voie accessoire atrioventriculaire entre juin 1981 et juin 1986. La moyenne ďâge des patients était de 30 ans (écart 6–66) avec une prépondérance de mâles (59 pour cent). Les maladies cardiaques associées ont été trouvées chez 18 patients (9.9 pour cent). Ľinduction de ľanesthésie fut faite avec des barbituriques-relaxants (83 pour cent) ou narcotiques-benzodiazépine-relaxant (17 pour cent) sans complication dans tous les cas. Pour 14 pour cent des cas une technique utilisant des narcotiques-relaxants a été employée pour le maintien de ľanesthésie alors que pour la balance on a utilisé de ľisoflurane (29 pour cent), de ľenflurane (34 pour cent), ou de ľhalothane (22 pour cent). La relaxation musculaire a été obtenue par la d-tubocurarine pour 35 procédures (18 pour cent) et du pancuronium pour le restant des procédures 162 (82 pour cent). Il n’y avait aucune corrélation significative entre les arythmies peropératoires et le type ďanesthésie utilisé. Tout en reconnaissant ľomniprésence ďune possibilité ďarythmie maligne, notre expérience (dans les limites de ľanalyse rétrospective) suggère que la majorité de ces patients peuvent subir avec succès une anesthésie générale standard.
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Irish, C.L., Murkin, J.M. & Guiraudon, G.M. Anaesthetic management for surgical cryoablation of accessory conducting pathways: a review and report of 181 cases. Can J Anaesth 35, 634–640 (1988). https://doi.org/10.1007/BF03020354
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DOI: https://doi.org/10.1007/BF03020354