[Anesthesia for elective caesarean section in patients with Wolff-Parkinson-White syndrome [WPW] - a case study]

Wolff-Parkinson-White syndrome [WPW] is an uncommon cardiac disorder which occurs due to presence of an aberrant pathway between atria and ventricles. Owing to its life threatening complications like paroxysmal supra ventricular tachycardia [PSVT] and atrial fibrillation [AF], this syndrome has been considered a challenge for anesthesiologists. We report a known case of WPW syndrome that had been scheduled for elective caesarean section and managed successfully under general anesthesia. Management of the present case includes important points in the management of WPW syndrome

Pretreatment with remifentanil is associated with less succinylcholine-induced fasciculation

Succinylcholine is a popular muscle relaxant and one of its most common side effects is muscle fasciculation. The purpose of this study was to evaluate the efficacy of remifentanil in preventing succinylcholine-induced fasciculation in patients undergoing general anesthesia. In aprospective, double blind study, 60 ASA I and II patients were randomly assigned into two groups [30 each] to receive either remifentanil 1 micro g/kg [Group R], or saline 3 ml [Group S] as a pretreatment agent, one minute before induction of general anesthesia by propofol, fentanyl, and 1.5 mg/kg succinylcholine. The duration and the intensity of fasciculation were assessed using a four-point rating scale. Data were analyzed by Mann-Whitney U-test, Fisher exact test and Student-t-test using SPSS software. In the remifentanil group the duration [p<0.001] and the intensity [p<0.001] of fasciculation were lower compared to the saline group. However the incidence of bradycardia was higher in the remifentanil group in comparison to the group which received normal saline. Our findings indicate that remifentanil can reduce the duration and the intensity of succinylcholine induced fasciculation. However, it induces greater bradycardia