Perioperative Anesthesia management for Lown-Ganong-Levine syndrome in resource limited area. A case report

Abstract

The Lown-Ganong-Levine syndrome is a clinical illness characterized by tachycardia and ECG manifestations of a short PR interval and normal QRS duration. Although the incidence is thought to be less than one in a million, it is very fatal if it does occur. Interdepartmental communication is very important for that symptomatically as well high risk for LGL patients. Malignant hyperthermia is one feared anesthesia related complication in patent with LGL syndrome, so that any triggering factor like sux and halogenated inhalational anesthetic agent must be avoided. Therefore, every clinician should consider this complication in patients with abnormal electrocardiographic findings; especially normal QRS complex is accompanied with short PR interval and tachycardia. Case presentation: 45 years old para 3 gravida 4 mother’s present with the diagnosis of APM secondary to huge 20cm x 21cm subserous myoma. She also had mild mitral regurgitation and LGL syndrome schedule for the procedure of total abdominal hysterectomy. Previously she had one cesarean section 10 years back for indication of failed induction under spinal anesthesia. She had shortness of breathing when she lies on supine position and also had palpitation, shortness of breathing and syncope during exercise. Otherwise she had no history of other chronic medical illness like diabetic mellitus and asthma and hypertension. Conclusion: Patients with LGL syndrome can be successfully managed with adequate preoperative planning, appropriate selection of safe anesthetic agent and anesthesia plan, cautious intraoperative monitoring, minimizing of factors that can trigger perioperative tachyarrhythmia, malignant hyperthermia, and cardiac arrest as well as effective management of postoperative pain.