Anesthetic management of a patient with asymptomatic ventricular tachycardia

There are many causes of ventricular arrhythmias in pediatric patients, even those with structurally normal hearts. However, in young patients with ‘normal’ hearts, sustained ventricular arrhythmias are relatively rare. The primary concern of the physician is to identify which patients have benign ventricular arrhythmia patterns and which are at risk for sudden cardiac death. Even in asymptomatic patients, the choice of anesthetic agents may be important to minimize precipitation of episodes of tachyarrhythmias. This clinical report describes the anesthetic considerations for an asymptomatic child with a history of sustained premature ventricular contractions, ventricular tachycardia, and bigeminy. This child had chronic serous otitis media requiring repeat tympanostomy and tube replacement. This case report outlines the initial cancellation of anesthesia because of sustained arrhythmias, and subsequent conduct of the anesthesia for the case, as well as the considerations in the selection of the drugs when a child presents with significant ventricular arrhythmia.