Objective: Patients with
Wolff-Parkinson-White (WPW) Syndrome require risk assessment to determine their
potential for sudden cardiac death. Transesophageal electrophysiology studies
(TEEPS) are an effective risk stratification tool. The purpose of this study is
to describe a minimially invasive, effective anesthetic technique to employ
during transesophageal electrophysiology studies. Methods: A retrospective
review of anesthetic technique utilized during TEEPS. Inclusion criteria; WPW
on ECG; age <18 years; and no history of tachycardia, palpitations, or
syncope and patient had TEEPS under monitored anesthesia care (MAC). Midazolam,
Fentanyl, and Propofol were used in various combinations. Sevoflurane was used
during induction period in all GA cases and discontinued 10 minutes prior to
initiation of TEEPS. Results: Inclusion criteria were met by 20 patients with
an average age of 11.9 years, average weight of 48.9 kg and average height of
149.2 cm. IV sedation was performed on 15%, MAC on 10% and GA in remainder.
Airway management techniques included 13.3% LMA, 20% endotrachael tube (ETT)
and 66% mask. IV sedation, the initial anesthetic, was found to be cumbersome
and uncomfortable. Next was ETT and LMA but trouble pacing was encountered due
to positional change of the esophagus relative to the left atrium during
ventilation. Mask induction was then performed in remaining 10 patients with
TEEPS probe inserted through a nare while anesthesiologist continued mask
ventilation. All mask procedures were successful without complications.
Conclusions: Induction of anesthesia to perform TEEPS procedures on pediatric
patients with Wolff-Parkinson-White syndrome underwent numerous attempts to
make the procedure easy, reliable and reproducible for anesthesia and electrophysiologist.
The eventual technique that proved to meet these criteria during a
transesopheagel electrophysiology procedure was utilization of mask induction
with continuous IV sedation.
Cite this paper
Gilly, G. , Hoyt, W. , Harmon, D. , Busch, E. , Nossaman, B. , Broussard, D. and Snyder, C. (2015) Anesthetic Technique for Transesophageal Electrophysiology Studies in Pediatric Patients with Wolff-Parkinson-White Syndrome. Open Journal of Pediatrics
, 17-22. doi: 10.4236/ojped.2015.51004
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