Prem Kumar

Abstract

Wolff-Parkinson-White (WPW) syndrome is a type of pre-excitation syndromewhere part of cardiac ventricles are activated too early by virtue of an accessory pathway, that directly attaches atria and ventricles, thereby allowing electrical activity to bypass AV node, thus leading to episodes of tachycardia which can be either asymptomatic or may present with dyspnoea on exertion or with palpitation. As it’s a rare condition, we report 3 cases of WPW Syndrome which adds more evidence to the current literature. The anaesthetic management can be challenging and has to be customized to the nature of the surgery and the patient to avoid life-threatening tachyarrhythmias. Messages: Perioperative management of WPW syndrome is challenging and requires good pre-operative planning and adequate preparation for intraoperative and post-operative period. Keywords : Anesthesia, Arrhythmias, Cardiac, Ebstein’s anomaly, General, Laparotomy, Perioperative period, WPW syndrome.

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Abstract

Background: Ephedrine, an ?1 and β agonist, that increases blood flow to muscles and thus increases the cardiac output. This concept is used in this study as speed by which the drug reaches the neuromuscular junction partly determines the onset of action of muscle relaxants. Our hypothesis was that ephedrine could hasten the onset of action of rocuronium bromide. The onset time of rocuronium was shorter after administration of ephedrine and there was no difference in the laryngoscopic viewsand hemodynamics between the two groups. Aim: Evaluation of the effects of a single dose of ephedrine on the onset time of rocuronium bromide and hemodynamic parameters during induction sequence and on the laryngoscopic views. Settings and Design: Prospective randomized double blinded study. Materials and Methods: 50 patients of the age 18 years or above belonging to ASA I or II posted for elective ENT surgeries under general anaesthesia were randomly allocated into two groups, namely Group E (ephedrine) and Group S(saline) by computer generated random allocation. Statistical Analysis: Onset time of rocuronium, POGO score and hemodynamics were analyzed using student’s t-test and the results are shown as mean and standard deviation. Results: The onset time of neuromuscular blockade for tracheal intubation was significantly shorter in ephedrine group. Hemodynamic parameters were comparable in both groups, so were the laryngoscopic views. Conclusion: Pre induction ephedrine administration dose of 70 mcg/kg hastens the onset of action of rocuronium bromide with minimal hemodynamic changes.   Keywords: Airway, Ephedrine, Neuromuscular junction, Rocuronium, Single twitch stimulation, TOF, Train of four.

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