Anesthetic Management in a Patient with Wolff-Parkinson-White Syndrome Undergoing Radical Nephrectomy: A Case Report

Abstract

Patients with Wolff-Parkinson-White (WPW) Syndrome present a significant challenge when undergoing anesthetic procedures, as there is always a latent risk of life-threatening arrhythmias triggered by surgical stimuli, perioperative stress, or even during anesthetic induction and emergence. We present the case of a 53-year-old patient with a recent diagnosis of WPW, demonstrating a characteristic "Delta Wave" on electrocardiography and associated symptoms of precordial pain and palpitations, in whom a potentially malignant renal tumor was incidentally discovered during imaging evaluation. Given the inherent risk of tumor progression and metastatic disease, surgical intervention was prioritized by a multidisciplinary team after careful cardiovascular risk assessment. The patient underwent a Simple Radical Nephrectomy without having previously received accessory pathway ablation via electrophysiological intervention. The anesthetic management focused on the careful selection of drugs with low arrhythmogenic potential, antiarrhythmic properties, strict hemodynamic and electrocardiographic monitoring, and the availability of antiarrhythmic agents and synchronized electrical cardioversion in the operating room. The procedure resulted in a favorable and uneventful perioperative outcome despite the elevated risk of developing tachyarrhythmias.