General Anaesthesia for Cesarean Section in a Parturient with Long QT Syndrome: A Case Report and a Review of Literature

Long QT syndrome patients are at high risk of developing ventricular arrhythmia and cardiac arrest, so that the anesthetic technique used for these patients must avoid anything that will induce an arrhythmia such as tachycardia, hypotension or increased catecholamine release by pain or stress.

A 28 -yr-old woman was scheduled for an elective, repeat cesarean section at 36 weeks gestation. She was diagnosed long QT syndrome at age 22 and an automatic implantable cardiac defibrillator (AICD) was implanted. During her pregnancy, parturient was hospitalized at 35 weeks gestation because of fetal bradycardia and obstetrician scheduled cesarean section at 36 weeks gestation. Before induction of anaesthesia, esmolol 200mcg.kg.min-1 was started for prevention of ventricular dysrhythmia during laryngoscopy and tracheal intubation. After preoxygenation, anaesthesia was induced with fentanyl 100mcg, propofol 200mg, rocuronium 100mg and trachea was intubated at 45th seconds. Esmolol infusion rate was reduced gradually to parturient’s haemodynamic parameters during surgery and was stopped at end of the surgery. At 4th minutes of the surgery, fetus was deliveried but there is no heart rate and breathing of baby. Following cardiac compression for 45 seconds, heart rate and breathing of baby returned. Anaesthesia was maintained with 1 MAC sevoflurane and 100 mcg fentanyl. Parturient’s blood pressure and heart rate remained within normal limits during surgery.

Consequently, if parturient does not accept regional anaesthesia, in case of an emergency cesarean section, general anaesthesia can be safely used with optimized preoperative evaluation, close monitoring and carefully anaesthetic management.