2024 FSA Podium and Poster Abstracts

P039: SUCCESSFUL ANESTHETIC MANAGEMENT OF A PATIENT WITH LOWN-GANONG-LEVINE SYNDROME
Sandy Ren, MD; Carol Valerio, MD; University of Miami Health System / Jackson Memorial Hospital

Introduction/Background: Lown-Ganong-Levine syndrome (LGL) is a rare, pre-excitation cardiac conduction abnormality affecting less than 1% of the population [1]. Anesthetic risks include life-threatening perioperative arrhythmias, malignant hyperthermia, and cardiac arrest; however, there is a dearth of standardized protocol regarding LGL preoperative evaluation, intraoperative anesthetic plan, and defensive strategy for avoiding and aborting complications [2].

Case presentation: We present the case of a 38-year-old female with LGL with acute cholecystitis scheduled for laparoscopic cholecystectomy with intraoperative cholangiogram. Other medical history for the patient includes chronic pyelonephritis, last treated two months prior and with no present symptoms. The patient endorsed good exercise capacity, denied previous exposure to anesthesia, and was unaware of any adverse events to anesthesia in her family. Her physical exam was positive for a tender right upper quadrant with an unremarkable cardiopulmonary exam. A preoperative electrocardiogram was obtained, revealing sinus arrhythmia with a shortened PR-interval at 100ms, consistent with LGL. Given the urgency of the case, the patient’s stable present cardiopulmonary picture, and her exercise capacity, we proceeded with total intravenous anesthesia with cardioversion pads placed prior to incision and had adenosine readily available. Sympathetic triggers such as anticholinergic and sympathomimetic drugs were avoided. Patient tolerated the anesthesia and surgery course well with no complications and was discharged on post-operative day one.

Discussion/Conclusion: A myriad of surgical emergencies and urgencies occur in combination with obscure medical diagnoses patients carry with no clear clinical burden of symptoms. As anesthesiologists, it is our duty to safely ensure the patient can tolerate the surgery given their medical history and current clinical picture, optimizing the patient’s health state and delivery anesthesia in a tolerable fashion. Our team executed a successful literature-informed plan guided by preoperative EKG evaluation, thorough history taking, placing cardioversion pads in anticipation of shockable rhythms, having adenosine available, avoiding known precipitating agents such as inhalational anesthetics, and employing total intravenous anesthesia in a patient with LGL.

Sources:

[1] LOWN B, GANONG WF, LEVINE SA. The syndrome of short P-R interval, normal QRS complex and paroxysmal rapid heart action. Circulation. 1952 May;5(5):693-706.

[2] Sharma MK, Misra S. Anaesthetic management of a patient with Lown Ganong Levine syndrome-a case report. Med J Armed Forces India. 2011 Jul;67(3):285-7. doi: 10.1016/S0377-1237(11)60064-6. Epub 2011 Aug 7. PMID: 27365828; PMCID: PMC4920821.