Sugammadex Reversal in the Anesthetic Management of Wolff-Parkinson-White
59 MDW San Antonio United States
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A 16 year old, 52 kg male with no past medical history, no medications, and an ASA class of I, initially presented for seven dental extractions. He was determined to be a Mallampati II, with mouth opening and thyromental distance of 2cm each. His anesthetic perioperative management is detailed in the table below. Five minutes after the start of the procedure, the patient was noted to be in a sinus bradycardia rhythm of 50 BPM and was provided ephedrine. Shortly thereafter, his ECG monitor began displaying delta waves and shortened PR intervals. He became tachycardic up to the110s and the decision was made to cancel the surgery. He had a 44 train of four following Sugammadex reversal. His heart rate ranged from 50 - 110, and his blood pressure ranged from 9540 to 13090. He was referred to a pediatric cardiologist and electrophysiologist for further evaluation. See figures 1, 2.Upon re-presentation 5 months later, the patient now had a past medical history of confirmed WPW, ASA class II, presenting for the same procedure. A crash cart and emergency antiarrhythmic Amiodarone were kept nearby. His anesthetic perioperative management is detailed in the table below. He had a 44 train of four after Sugammadex reversal. His heart rate increased to 110 at induction, returning to baseline within 30 seconds, and the rest of his perioperative course was uneventful. His heart rate ranged from 50-110, and his blood pressure ranged from 9050 to13080. No WPW morphologies were seen on ECG during the second operative course.
- Anatomy and Physiology
- Medicine and Medical Research