Safe Anesthesia for Brugada Syndrome in Pregnancy: Insights From a Retrospective Case Series

TL;DR

This study shows that regional anesthesia, like epidural, can be safely used in pregnant women with Brugada syndrome when combined with continuous monitoring and careful management.

Contribution

The paper provides novel clinical insights and safety data for anesthetic management in Brugada syndrome pregnancies.

Findings

Regional anesthesia was used in 19 out of 21 cases without arrhythmic complications.

Continuous ECG monitoring during labor and postpartum was associated with favorable maternal and neonatal outcomes.

No arrhythmic or hemodynamic complications were observed in patients receiving epidural analgesia.

Abstract

Introduction

Brugada syndrome (BrS) is a cardiac channelopathy associated with sudden cardiac death and presents unique anesthetic challenges during pregnancy due to autonomic fluctuations and sensitivity to sodium channel-blocking agents. This study examines anesthetic strategies and outcomes in pregnant women with BrS.

Methods

We conducted a retrospective review of pregnant patients with confirmed or suspected BrS who delivered at our institution between 2012 and 2023. Data collected included ECG patterns, family history, anesthetic technique and agents, delivery details, and maternal and neonatal outcomes.

Results

Ten women accounted for 21 pregnancy-related events. Regional anesthesia was used in 19 cases: 18 with epidural analgesia (0.2% ropivacaine and opioids) and one spinal with bupivacaine. One patient received remifentanil, and another underwent general anesthesia. No arrhythmic or hemodynamic complications were observed. Mean epidural duration was 5.34 hours. All patients underwent continuous ECG monitoring during labor and for 24 hours postpartum. All neonates had favorable outcomes.

Discussion

Epidural anesthesia appears safe in BrS pregnancies when combined with continuous monitoring and multidisciplinary care. While serum anesthetic concentration is the primary arrhythmogenic risk factor, caution is advised with prolonged infusions due to potential systemic accumulation. The postpartum period remains a high-risk phase requiring extended surveillance.

Conclusion

With appropriate planning and monitoring, neuraxial anesthesia can be safely employed in BrS pregnancies. These findings support the development of tailored peripartum management protocols for this high-risk population.

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