Li XX, Yao YF, Tan HY. Anesthetic management of a patient with preoperative R-on-T phenomenon undergoing laparoscopic-assisted sigmoid colon resection: A case report. World J Clin Cases 2023; 11(9): 2098-2103 [PMID: 36998950 DOI: 10.12998/wjcc.v11.i9.2098]
Corresponding Author of This Article
Hong-Yu Tan, MD, PhD, Chief Doctor, Professor, Department of Anesthesiology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Street, Haidian District, Beijing 100142, China. maggitan@yeah.net
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2023; 11(9): 2098-2103 Published online Mar 26, 2023. doi: 10.12998/wjcc.v11.i9.2098
Anesthetic management of a patient with preoperative R-on-T phenomenon undergoing laparoscopic-assisted sigmoid colon resection: A case report
Xiao-Xi Li, Yun-Feng Yao, Hong-Yu Tan
Xiao-Xi Li, Hong-Yu Tan, Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
Yun-Feng Yao, Department of Unit Ⅲ & Ostomy Service, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
Author contributions: Li XX conceived the study and wrote the manuscript; Yao YF participated in the diagnosis and treatment of the patient; Tan HY supervised the study; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yu Tan, MD, PhD, Chief Doctor, Professor, Department of Anesthesiology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Street, Haidian District, Beijing 100142, China. maggitan@yeah.net
Received: December 26, 2022 Peer-review started: December 26, 2022 First decision: January 12, 2023 Revised: January 18, 2023 Accepted: February 21, 2023 Article in press: February 21, 2023 Published online: March 26, 2023
Abstract
BACKGROUND
The R-on-T phenomenon is a malignant arrhythmia associated with potentially catastrophic consequences. It may initiate ventricular tachycardia or ventricular fibrillation, which can result in syncope or sudden cardiac death. This manifestation poses a great challenge for anesthesiologists. However, it is rarely encountered in the perioperative setting.
CASE SUMMARY
We herein present a case in which the R-on-T phenomenon was incidentally revealed by 24-h Holter monitoring in a patient diagnosed with sigmoid colon cancer. Careful evaluation and treatment with mexiletine were carried out preoperatively under consultation with a cardiovascular specialist, and surgery was uneventfully performed under general anesthesia after thorough preparation.
CONCLUSION
Physicians should be vigilant about this infrequent but potentially fatal arrhythmia. Our experience suggests that the anesthetic process can be greatly optimized with careful preparation.
Core Tip: The R-on-T phenomenon is associated with an increased risk of fatal arrhythmia. It may initiate ventricular tachycardia and ventricular fibrillation, and its appearance seem to be associated with a poor prognosis. However, this phenomenon is rarely encountered in the preoperative inpatient setting. The anesthetic management of patients with this particular manifestation poses a great challenge. We herein describe a patient who was scheduled for laparoscopic-assisted sigmoid colon resection when the R-on-T phenomenon was incidentally discovered. Our experience suggests that the anesthetic process can be greatly optimized by detailed preoperative assessment and preparation with interdisciplinary cooperation.
