Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.031
Brazilian Journal of Anesthesiology
Case Report

Implication of AV node blockers in patients with end-stage renal disease undergoing head and neck surgery; BRASH syndrome: a case report

Implicação de bloqueadores de nó AV em pacientes com doença renal em estágio terminal submetidos a cirurgia de cabeça e pescoço; Síndrome BRASH: um relato de caso

Ju Ik Park; Moon Sik Jung; Hyunho Lee; Hochang Kim; Jimi Oh

Downloads: 0
Views: 208

Abstract

Abstract: BRASH (Bradycardia, Renal failure, Atrioventricular [AV]-node blocker medications, Shock, and Hyperkalemia), a novel syndrome, is a synergistic interaction between AV node blockers and hyperkalemia, resulting in bradycardia. We report a case of BRASH syndrome with marked bradycardia in a patient with End-Stage Renal Disease (ESRD) associated with synergistic interaction between mild hyperkalemia and AV node blockers. Anesthesiologists should be aware of these clinical features, in which ESRD patients with baseline mild hyperkalemia are particularly susceptible to bradycardia. This report will help in its early recognition as well as enable comprehensive and appropriate treatment strategies without further invasive therapy.

Keywords

Beta-blocker, Bradycardia, End-stage renal disease

Resumo

BRASH (sigla em inglês para bradicardia, insuficiência renal, medicamentos bloqueadores do nó atrioventricular [AV], choque e hipercalemia), uma nova síndrome, é uma interação
sinérgica entre bloqueadores do nó AV e hipercalemia, resultando em bradicardia. Relatamos um caso de síndrome BRASH com bradicardia acentuada em um paciente com doença renal em estágio terminal (DRET) associada à interação sinérgica entre hipercalemia leve e bloqueadores do nó AV. Os anestesiologistas devem estar cientes dessas características clínicas, nas quais os pacientes com DRET com hipercalemia leve basal são particularmente suscetíveis à bradicardia. Este relatório ajudará no seu reconhecimento precoce, bem como possibilitará estratégias de tratamento abrangentes e adequadas sem terapia invasiva adicional.
 

Palavras-chave

Bloqueador beta, Bradicardia, Doença renal terminal  

References

1 Bonvini RF, Hendiri T, Anwar A. Sinus arrest and moderate hyperkalemia. Ann Cardiol Angeiol (Paris). 2006;55:161-3.

2 Farkas JD, Long B, Koyfman A, Menson K. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. J Emerg Med. 2020;59:216-23.

3 Aziz EF, Javed F, Korniyenko A, Pratap B, Cordova JP, Alviar CL, et al. Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block. Heart Int. 2011;6:e12.

4 Vuckovic K, Richlin D. Bradycardia induced by hyperkalemia. AAOHN J. 2004;52:186-7.

5 Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019;140:e382-482.
 


Submitted date:
08/09/2020

Accepted date:
04/25/2021

60b0eee7a9539552dd669ad3 rba Articles

Braz J Anesthesiol

Share this page
Page Sections