Anesthesia in patients with Brugada syndrome: two case reports.

BACKGROUND: Brugada syndrome is a rare disease. It causes sudden cardiac arrest, which is a serious life-threatening event. Sudden cardiac death mostly results from coronary artery disease. However, patients with Brugada syndrome show normal cardiac anatomy and no evidence of ischemia or electrolyte imbalance. Anesthesia in patients with Brugada syndrome is challenging due to its unpredictable nature, and is worth our attention. CASE PRESENTATION: We report two cases of Brugada syndrome during anesthesia. In case one, a 31-year-old Filipino laborer was scheduled for laparoscopic appendectomy. The patient denied any preexisting cardiac disease. The preoperative vital signs were stable, with mild fever of 37.9 °C. The operation was smooth. During the emergence period, the patient suffered from sudden onset of ventricular tachycardia. After resuscitation, the cardiac rhythm returned to normal. Later, he was confirmed to have a genetic trait of Brugada syndrome. In case two, a young Taiwanese patient with pre-diagnosed Brugada syndrome underwent an operation. The perioperative precautions were taken to prevent the occurrence of ventricular arrhythmia. The surgery was uneventful. CONCLUSIONS: Brugada syndrome, although rare, has the highest incidence in South East Asian healthy young males. It brings attention to possible fatal cardiac arrhythmia in this population. Careful preoperative evaluation and perioperative management can help reduce the harmful outcome of the disease and prevent any untoward events.

Nitrogen-doped carbon armored Cobalt oxide hollow nanocubes electrochemically anchored on fluorine-doped tin oxide substrate for acidic oxygen evolution reaction.

Developments of non-precious metal based active and stable catalysts are of great importance and challenge to green hydrogen production from acidic electrocatalytic water splitting. Design of composite catalysts with synergy between active and stable components proves to be a promising approach. Herein, N-doped carbon armored Co3O4 hollow nanocubes electrochemically anchored on fluorine-doped tin oxide (FTO) substrates are developed as efficient and stable catalysts for acidic oxygen evolution reactions. Co3O4 acts as the active component with N-doped carbon coating layer serving as the stable protection component, shielding Co3O4 from direct attack of anodic dissolution. Electrochemical fixation offers firm holding of the composite catalyst onto acid-tolerant FTO substrates and hollow nanocubes serve as nano-reactors for confined fast reactions. Under optimal conditions, the composite catalyst achieves an overpotential of 465 mV at 10 mA cm-2 in 0.5 M H2SO4, and stays stable for 12 hr with a 10% increment in applied potentials.