Perioperative Management of a Patient With Wolff-Parkinson-White Syndrome Undergoing Thyroidectomy With Bilateral Modified Neck Dissection and the Role of Dexmedetomidine: A Case Report

TL;DR

This case report describes the successful anesthetic management of a patient with WPW syndrome undergoing thyroid surgery with neck dissection.

Contribution

The report highlights the use of dexmedetomidine to manage hemodynamic stability in WPW patients during high-risk thyroid surgery.

Findings

Dexmedetomidine helped maintain rhythm and hemodynamic stability during surgery.

Careful anesthetic planning and avoidance of vagal/sympathetic stimulation were critical.

The case adds to limited literature on anesthetic management for WPW syndrome during thyroidectomy.

Abstract

Wolff-Parkinson-White (WPW) syndrome is characterized by the presence of an accessory conduction pathway in the heart, predisposing patients to tachyarrhythmias and sudden cardiac death. The perioperative management of these patients poses a significant challenge to the anesthetist due to the increased risk of arrhythmias, particularly under anesthetic and surgical stress.

We report the successful perioperative management of a patient with WPW syndrome undergoing thyroidectomy with bilateral modified neck dissection. The nature of the surgery increased the risk of vagal stimulation, given the proximity of the carotid sinus to the surgical field. Careful anesthetic planning and intraoperative vigilance were essential to prevent complications. Strategies included careful selection of anesthetic agents, avoidance of sympathetic and vagal stimulation, and the use of dexmedetomidine to maintain hemodynamic and rhythm stability. This case contributes to the limited literature available on the anesthetic management of WPW syndrome in the context of thyroid surgeries with neck dissection.

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