Perioperative Management in a Patient with WPW Syndrome undergoing Plastic Surgery.

Abstract

Perioperative management of patients with preexcitation may become quite challenging, especially if there is no time for adequate preoperative investigation and clinical optimisation, as in emergencies, or even worse, in undiagnosed cases. It is possible that the poorly controlled or unknown underlying electrophysiological abnormality will become unmasked during anaesthesia and surgery, giving rise to potentially life-threatening arrhythmias. In the literature, pre-excitation syndromes have been mainly approached from the view of the disease (i.e., presentation, diagnosis, treatment), while anaesthetic data are scarce. This case report aims to focus on the perioperative management of patients with WPW. Conclusion; Managing such cases provides an opportunity to revisit important considerations on Wolff-Parkinson-White syndrome Avoiding neuromuscular blockers may make a difference in avoiding arrhythmias when laryngeal mask airway / general anaesthesia is required in patients with Wolff-Parkinson-White syndrome. Sympathetic stimulation should be avoided as it may shorten the refractory period of AP and alleviate life-threatening arrhythmias.