Brugada Syndrome and Anesthesia: A Systematic Review

Brugada Syndrome is an inherited disorder causing specific changes on electrocardiogram (ECG) pattern of right bundle branch block and persistent ST elevation in right precordial leads increases the risk of cardiac arrest and fatal arrhythmia. Patients with brugada are prone to abnormal cardiac rhythms which can be induced by alcohol, stress, vagal stimulation, and certain medications. Thus medications are divided into different classes from I to III with I carrying the most evidence for potential arrhythmia while III being the least likely. Exceptional care needs to be taken to avoid anesthetic and analgesic during surgeries for such patients as several of the known anesthesia medications can lead to arrhythmia in these patients. In this review we aimed to study the effect different anesthetic and analgesic medication could have on patients with brugada syndrome. We conducted a systematic review following PRISMA guidelines to query PubMed, Embase, Cochrane library and ProQuest electronic databases. Mesh combinations and synonyms of “Brugada Syndrome”, “Anesthesia”, “Analgesics” were used. We included all original human studies that focused on outcomes of anesthetic and analgesics on patients with brugada. After screening 1149 studies, we included 49 articles consisting of a total of 1414 subjects for qualitative analysis. We found local analgesics to be least likely to lead to potential arrhythmic complications with other systemic and inhaled agents having a risk although the risk varied because of multitude of reasons ranging from type of drug to patient factors like the patient’s condition and type of Brugada. We concluded that anesthetic although could be used for individuals with Brugada the type of anesthetic to be used should be selected keeping the potential cardiac risk under consideration.