Wpw syndrome have an accessory pathway which allows electrical conduction between atria and

ventricles at site other than AV node which does not have the the rate slowing property of AV node.
Patients are usually asymptomatic but it may lead to reentrant tachycardia and sudden cardiac arrest
which warrants cautious managenment

The goal during the perioperative management of anaesthesia is to avoid any factor that increases the
sympathetic activity such as pain,anxiety, lighter plane of anaesthesia and the stress response of
intubation.

Regional anaesthesia is preferred over general anaesthesia as it avoids polypharmacy , noxious stimulus
of laryngoscopy and intubation. Since the patient is a parturient ,general anaesthesia always carry a risk
of difficult Airway and aspiration.

We avoided spinal anaesthesia as sympathetic blockade in spinal anaesthesia can lead to sudden
hypotension and bradycardia. The vasopressors which needed to treat this hypotension can be an
initiator of tachycardia and arrhythmia

Hence we conducted graded epidural anaesthesia which provides the advantage of hemodynamic
stability and post operative pain relief .We adequately preload the patient which ensures adequate
atrial filling and thereby avoids sympathetic stimulation and arrythmia. We kept phenylephrine ready in
place of ephedrine as it avoids tachycardia.

We conducted epidural anaesthesia in a graded manner because even if hypotension occurs it will be
gradual and will not invoke tachycardia in addition to providing adequate time for fluid replacement.We
avoided adrenaline premixed solution so as to prevent arrythmia in the event of intravascular catheter
migration

Psvt and atrial fibrillation are the common adverse events and has to be treated with drugs like
adenosine or metaprolol if patient is stable and cardioversion is needed if patient is unstable...

Post operative pain relief provided by epidural anaesthesia is atmost important to prevent arrythmias in
the post op period...