Anaesthesia with remifentanil and rocuronium for caesarean section in a patient with long-QT syndrome and an automatic implantable cardioverter-defibrillator

A 24-year-old woman with congenital long-QT syndrome (LQTS) required caesar ean section at 32 weeks' gestation. Her risk of premature death from malign ant ventricular tachyarrhythmias had necessitated implantation of an automa tic cardioverter-defibrillator (AICD) with pacemaker capability. The patien t expressed a preference for general anaesthesia. To minimise the risk of i ncreased serum catecholamine concentrations and consequent ventricular arrh ythmias, an analgesia-based regimen was chosen. With cardioversion, defibri llation, and antitachycardia pacing functions of the AICD selectively deact ivated, anaesthesia was induced with bolus doses of thiopentone and remifen tanil. Rocuronium was used for neuromuscular block. Anaesthesia was maintai ned with nitrous oxide and isoflurane, supplemented by a remifentanil infus ion. We outline the pathophysiology and treatment of LQTS, and discuss the anaesthetic management of an obstetric patient with the congenital syndrome . This is the first reported case of caesarean section in a patient with an AICD, and the first description of the use of either remifentanil or rocur onium in LQTS. (C) 2000 Harcourt Publishers Ltd.