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Kim SH, Lee JG, Ju HM, Choi S, Yang H, Koo BN. Propofol prevents further prolongation of QT interval during liver transplantation. Sci Rep 2022; 12:4636. [PMID: 35301381 PMCID: PMC8931121 DOI: 10.1038/s41598-022-08592-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Here, we aimed to compare the effects of two anesthetic methods (desflurane inhalation anesthesia vs. propofol-based total intravenous anesthesia (TIVA)] on corrected QT interval (QTc) values during living donor liver transplantation. Altogether, 120 patients who underwent living donor liver transplantation were randomized to either the desflurane or TIVA group. The primary outcome was intraoperative QTc change. Other electrocardiogram, hemodynamic findings and postoperative outcomes were examined as secondary outcomes. QTc values were prolonged intraoperatively in both groups; however, the change was smaller in the TIVA group than in the desflurane group (PGroup × Time < 0.001). More patients had QTc values of > 500 ms in the desflurane group than in the TIVA group (63.3% vs. 28.3%, P < 0.001). In patients with preoperative QTc prolongation, QTc was further prolonged in the desflurane group, but not in the TIVA group (PGroup × Time < 0.001). Intraoperative norepinephrine and vasopressin use were higher in the desflurane group than in the TIVA group. Propofol-based TIVA may reduce QTc prolongation during living donor liver transplantation compared to that observed with desflurane inhalational anesthesia, particularly in patients with preoperative QTc prolongation. Additionally, patients managed with propofol-based TIVA required less vasopressor during the procedure as compared with those managed with desflurane inhalational anesthesia.
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Affiliation(s)
- Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Jae Geun Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyang Mi Ju
- Department of Anesthesiology and Pain Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - SuYoun Choi
- Department of Anesthesiology and Pain Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyukjin Yang
- Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bon-Nyeo Koo
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Niimi N, Yuki K, Zaleski K. Long QT Syndrome and Perioperative Torsades de Pointes: What the Anesthesiologist Should Know. J Cardiothorac Vasc Anesth 2020; 36:286-302. [PMID: 33495078 DOI: 10.1053/j.jvca.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Naoko Niimi
- Department of Anesthesiology, Juntendo University, Tokyo, Japan.
| | - Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Katherine Zaleski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA; Department of Anesthesia, Harvard Medical School, Boston, MA
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Ataro G. Anesthesia for children with long QT syndrome: Challenges and solutions from pediatric studies. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND The impact of volatile anesthetics on patients with inherited long QT syndrome (LQTS) is not well understood. This is further complicated by the different genotypes underlying LQTS. No studies have reported on the direct effects of volatile anesthetics on specific LQTS-associated mutations. We investigated the effects of isoflurane on a common LQTS type 1 mutation, A341V, with an unusually severe phenotype. METHODS Whole cell potassium currents (IKs) were recorded from HEK293 and HL-1 cells transiently expressing/coexpressing wild-type KCNQ1 (α-subunit), mutant KCNQ1, wild-type KCNE1 (β-subunit), and fusion KCNQ1 + KCNE1. Current was monitored in the absence and presence of clinically relevant concentration of isoflurane (0.54 ± 0.05 mM, 1.14 vol %). Computer simulations determined the resulting impact on the cardiac action potential. RESULTS Isoflurane had significantly greater inhibitory effect on A341V + KCNE1 (62.2 ± 3.4%, n = 8) than on wild-type KCNQ1 + KCNE1 (40.7 ± 4.5%; n = 9) in transfected HEK293 cells. Under heterozygous conditions, isoflurane inhibited A341V + KCNQ1 + KCNE1 by 65.2 ± 3.0% (n = 13) and wild-type KCNQ1 + KCNE1 (2:1 ratio) by 32.0 ± 4.5% (n = 11). A341V exerted a dominant negative effect on IKs. Similar differential effects of isoflurane were also observed in experiments using the cardiac HL-1 cells. Mutations of the neighboring F340 residue significantly attenuated the effects of isoflurane, and fusion proteins revealed the modulatory effect of KCNE1. Action potential simulations revealed a stimulation frequency-dependent effect of A341V. CONCLUSIONS The LQTS-associated A341V mutation rendered the IKs channel more sensitive to the inhibitory effects of isoflurane compared to wild-type IKs in transfected cell lines; F340 is a key residue for anesthetic action.
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Erbaş M, Toman H, Şahin H, Kiraz HA, Barutcu A, Simsek T, Yener AU, Uzun M, Altinişik U. Comparison of effects of sugammadex and neostigmine on QTc prolongation in rabbits under general anesthesia. Acta Cir Bras 2015; 29:807-11. [PMID: 25517494 DOI: 10.1590/s0102-86502014001900007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/24/2014] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare the effects of sugammadex and neostigmine, used to antagonize the effects of rocuronium, on the QTc interval. METHODS This study used 10 adult New Zealand white rabbits of 2.5-3.5 kg randomly divided into two groups: sugammadex group (Group S, n:5) and neostigmine group (Group N, n:5). For general anesthesia administering 2 mg/kg iv propofol and 1 mcg/kg iv fentanyl, 0.6 mg/kg iv rocuronium was given. Later to provide reliable airway for all experimental animals V-Gel Rabbit was inserted. The rabbits were manually ventilated by the same anesthetist. After the V-Gel Rabbit was inserted at 2, 5, 10, 20, 25, 27, 30 and 40 minutes measurements were repeated and recorded. At 25 minutes after induction Group N rabbits were given 0.05 mg/kg iv neostigmine + 0.01 mg/kg iv atropine. Group S were administered 2 mg/kg iv sugammadex. RESULTS Comparing the QTc interval in the rabbits in Group S and Group N, in the 25th, 27th and 30th minute after muscle relaxant antagonist was administered the QTc interval in the neostigmine group rabbits was significantly increased (p<0.05). CONCLUSION While sugammadex, administered to antagonize the effect of rocuronium, did not significantly affect the QTc interval, neostigmine+atropine proloned the QTc interval.
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Affiliation(s)
- Mesut Erbaş
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hüseyin Toman
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hasan Şahin
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hasan Ali Kiraz
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ahmet Barutcu
- Department of Cardiology, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Tuncer Simsek
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ali Umit Yener
- Department of Cardiovascular Surgery, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Metehan Uzun
- Department of Physiology, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Uğur Altinişik
- Department of Anesthesiology and Reanimation, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia. J Clin Monit Comput 2015; 29:727-32. [PMID: 25637244 DOI: 10.1007/s10877-015-9659-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED In this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). CONCLUSION In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.
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Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth 2014; 112:217-230. [DOI: 10.1093/bja/aet412] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Venugopal A, Rajasree O, Koshy RC. Effect of anthracyclines and isoflurane on QTc interval. EGYPTIAN JOURNAL OF ANAESTHESIA 2014. [DOI: 10.1016/j.egja.2013.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- A. Venugopal
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, 11, India
| | - O. Rajasree
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, 11, India
| | - Rachel Cherian Koshy
- Department of Anaesthesiology, Regional Cancer Centre, Thiruvananthapuram, 11, India
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Fazio G, Vernuccio F, Grutta G, Re GL. Drugs to be avoided in patients with long QT syndrome: Focus on the anaesthesiological management. World J Cardiol 2013; 5:87-93. [PMID: 23675554 PMCID: PMC3653016 DOI: 10.4330/wjc.v5.i4.87] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/05/2013] [Accepted: 03/29/2013] [Indexed: 02/06/2023] Open
Abstract
Long QT syndrome incidence is increasing in general population. A careful pre-, peri- and post-operative management is needed for patients with this syndrome because of the risk of Torsades de Pointes and malignant arrhythmias. The available data regarding prevention of lethal Torsades de Pointes during anesthesia in patients with long QT syndrome is scant and conflicting: only case reports and small case series with different outcomes have been published. Actually, there are no definitive guidelines on pre-, peri- and post-operative anesthetic management of congenital long QT syndrome. Our review focuses on anesthetic recommendations for patients diagnosed with congenital long QT syndrome furnishing some key points for preoperative optimization, intraoperative anesthetic agents and postoperative care plan, which could be the best for patients with c-long QT syndrome who undergo surgery.
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Kozik TM, Wung SF. Acquired long QT syndrome: frequency, onset, and risk factors in intensive care patients. Crit Care Nurse 2013; 32:32-41. [PMID: 23027789 DOI: 10.4037/ccn2012900] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Acquired long QT syndrome is a reversible condition that can lead to torsades de pointes and sudden cardiac death. OBJECTIVE To determine the frequency, onset, frequency of medications, and risk factors for the syndrome in intensive care patients. METHODS In a retrospective chart review of 88 subjects, hourly corrected QT intervals calculated by using the Bazett formula were collected. Acquired long QT syndrome was defined as a corrected QT of 500 milliseconds or longer or an increase in corrected QT of 60 milliseconds or greater from baseline level. Risk factors and medications administered were collected from patients' medical records. RESULTS The syndrome occurred in 46 patients (52%); mean time of onset was 7.4 hours (SD, 9.4) from time of admission. Among the 88 patients, 52 (59%) received a known QTc-prolonging medication. Among the 46 with the syndrome, 23 (50%) received a known QT-prolonging medication. No other risk factor studied was significantly predictive of the syndrome. CONCLUSIONS Acquired long QT syndrome occurs in patients not treated with a known QT-prolonging medication, indicating the importance of frequent QT monitoring of all intensive care patients.
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Affiliation(s)
- Teri M Kozik
- Cardiac Research Department, Saint Joseph's Medical Center, Stockton, CA 95204, USA.
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Abstract
Prolonged QT syndrome is the most common genetic arrhythmia syndrome, and the majority of patients are undiagnosed. The syndrome is characterized by abnormally long ventricular repolarization (QT interval) on electrocardiogram, which may manifest as syncopal episodes, arrhythmias, or sudden death. Arrhythmias may be precipitated by stress or medications. There are few randomized controlled trials examining the safety of typical sedation medications in the patient with prolonged long-QT syndrome. This case describes the management of sedation in a patient with prolonged long-QT syndrome and then reviews the current literature regarding commonly utilized sedation medications.
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Srivastava A, Khan MA, Watkiss J. Post induction arrhythmia in a renal patient: an unexpected risk factor. Anaesthesia 2009; 64:439-43. [PMID: 19317712 DOI: 10.1111/j.1365-2044.2008.05783.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 44 year-old woman was anaesthetised for a transplant nephrectomy. About 10 min after induction of anaesthesia she had several runs of ventricular tachycardia followed by ventricular fibrillation requiring 30 s of cardiopulmonary resuscitation, after which she reverted to sinus rhythm. Review of her chest X-ray, suggested that the haemodialysis catheter (Permcath) position may have precipitated this event. However, subsequent investigation found that she had toxic serum levels of sotalol, with a prolonged corrected QT interval on the electrocardiogram. She was started on sotalol while her renal graft was functioning well but it was not reviewed when the graft started to fail and she had to commence haemodialysis. This led to the accumulation of sotalol and explains her serum sotalol value of 7.1 mg x l(-1) on the day of the event. Concentrations greater than 2.5 mg x l(-1) are generally considered toxic.
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Abstract
The long QT syndrome (LQTS) is a rare, congenital or acquired disease, which may lead to fatal cardiac arrhythmias (torsade de pointes, TdP). In all LQTS subtypes, TdPs are caused by disturbances in cardiac ion channels. Diagnosis is made using clinical, anamnestic and electrocardiographic data. Triggers of TdPs are numerous and should be avoided perioperatively. Sufficient sedation and preoperative correction of electrolyte imbalances are essential. Volatile anaesthetics and antagonists of muscle relaxants should be avoided and high doses of local anaesthetics are not recommended to date. Propofol is safe for anaesthesia induction and maintenance. The acute therapy of TdPs with cardiovascular depression should be performed in accordance with the guidelines for advanced cardiac life support and includes cardioversion/defibrillation and magnesium. Torsades de pointes may be associated with bradycardia or tachycardia resulting in specific therapeutic and prophylactic measures.
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Affiliation(s)
- S Rasche
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität, Dresden.
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Kazanci D, Unver S, Karadeniz U, Iyican D, Koruk S, Yilmaz MB, Erdemli O. A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG. Ann Card Anaesth 2009; 12:107-12. [DOI: 10.4103/0971-9784.51361] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Whyte SD, Sanatani S, Lim J, Booker PD. A Comparison of the Effect on Dispersion of Repolarization of Age-Adjusted MAC Values of Sevoflurane in Children. Anesth Analg 2007; 104:277-82. [PMID: 17242080 DOI: 10.1213/01.ane.0000252417.23986.6e] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND QT interval prolongation is associated with torsades des pointes (TdP), but is a poor predictor of drug torsadogenicity. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall, rather than QT interval prolongation per se. TDR can be measured on the electrocardiogram as the time interval between the peak and end of the T-wave (Tp-e). Thus Tp-e is a readily measured assay of drug torsadogenicity. Several anesthetic drugs prolong the QT interval, but their effect on TDR is largely unknown. METHODS We investigated the effects of sevoflurane on corrected QT (QTc) and Tp-e intervals in 54 unpremedicated ASA I-II children, aged 3-10 yr, who were randomized to receive sevoflurane 1, 1.25, or 1.5 MAC, age-adjusted. Twelve-lead electrocardiograms were recorded before and after sevoflurane exposure. QTc and Tp-e were compared within and among groups using 2-way analysis of variance. Change in Tp-e after sevoflurane exposure was the primary outcome measure. RESULTS Sevoflurane significantly prolonged preoperative QTc at all doses (P < 0.005), with no dose-response relationship, but had no effect on preoperative Tp-e. CONCLUSION Sevoflurane markedly prolongs the QTc in healthy children, but does not increase dispersion of repolarization as measured by the Tp-e interval, indicating low or no torsadogenicity, and making it unlikely to increase predisposition to TdP.
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Affiliation(s)
- Simon D Whyte
- Department of Pediatric Anesthesia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Abstract
UNLABELLED Volatile anesthetics may prolong the QTc interval and this may result in grave cardiac arrhythmias. We assessed the effect of desflurane on the QTc interval in 40 ASA physical status I or II patients. Volatile anesthetic induction with desflurane was performed, and after obtaining adequate level of anesthesia, QTc interval, heart rate, and noninvasive arterial blood pressure were measured. Prolongation of the QTc interval was observed within the first minute of anesthesia. There were no differences in QTc interval changes between sexes at any time. We conclude that desflurane prolongs the QTc interval, but that there are no differences between genders in sensitivity to this action. IMPLICATIONS We assessed the effect of desflurane on QTc interval in patients without cardiac diseases. Prolongation of the interval was evident by the first minute of desflurane anesthesia. There were no differences between female and male patients.
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Affiliation(s)
- Radoslaw Owczuk
- Departments of *Anaesthesiology and Intensive Therapy, and †Trauma Surgery, Medical University of Gdansk, Gdansk, Poland
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Whyte SD, Booker PD, Buckley DG. The Effects of Propofol and Sevoflurane on the QT Interval and Transmural Dispersion of Repolarization in Children. Anesth Analg 2005; 100:71-77. [PMID: 15616054 DOI: 10.1213/01.ane.0000140781.18391.41] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Prolongation of the QT interval is associated with torsades de pointes (TdP), especially in children or young adults with long QT syndromes. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall. Several anesthetic drugs prolong the QT interval, but their effect on TDR is unknown. TDR can be measured on the electrocardiograph (ECG) as the time interval between the peak and end of the T wave (Tp-e). We investigated the effects of propofol and sevoflurane on the corrected QT (QTc) and Tp-e intervals in 50 unpremedicated ASA physical status I-II children, aged 1-16 yr, who were randomized to receive propofol (group P) or sevoflurane (group S). Twelve-lead ECGs were recorded preoperatively and intraoperatively. Sevoflurane significantly prolonged the preoperative QTc; propofol did not. Neither anesthetic had any significant effect on the preoperative Tp-e. Sevoflurane increases the duration of myocardial repolarization in children to a larger extent than does propofol, but as the dispersion of repolarization appears unaffected, the risk of TdP is likely to be minimal with either anesthetic.
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Affiliation(s)
- Simon D Whyte
- Jackson-Rees Department of Anesthesia, Royal Liverpool Children's Hospital and the Liverpool University Department of Anesthesia, Liverpool, UK
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Owczuk R, Wujtewicz MA, Sawicka W, Wujtewicz M, Swierblewski M. Is prolongation of the QTc interval during isoflurane anaesthesia more prominent in women pretreated with anthracyclines for breast cancer? †. Br J Anaesth 2004; 92:658-61. [PMID: 15064247 DOI: 10.1093/bja/aeh132] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Inhalation anaesthetics and anthracycline chemotherapeutic drugs may both prolong the QT interval of the electrocardiogram. We investigated whether isoflurane may induce or augment QTc prolongation in patients who had previously received cancer chemotherapy including anthracycline drugs. METHODS Forty women undergoing surgery for breast cancer were included in the study. They were divided into two groups: (A) women previously treated with anthracyclines (n=20); and (B) women not treated with antineoplastic drugs (n=20). All patients received a standardized balanced anaesthetic in which isoflurane 0.5 vol% was used. The QT and corrected QT intervals were measured before anaesthesia, after induction and tracheal intubation, after 1, 5, 15, 30, 60 and 90 min of anaesthesia, and during recovery. RESULTS In both groups we observed a tendency to QTc prolongation, but statistically significant differences among baseline values and values observed during isoflurane-containing anaesthesia were seen only in group A. During anaesthesia, significant differences in QTc values between the two groups were observed. CONCLUSION In female patients pretreated with anthracyclines for breast cancer, the tendency to QTc prolongation during isoflurane-containing general anaesthesia was more strongly expressed than in patients without previous chemotherapy.
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Affiliation(s)
- R Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Debinki str. 7, 80-211 Gdansk, Poland.
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Habib AS, Gan TJ. Food and drug administration black box warning on the perioperative use of droperidol: a review of the cases. Anesth Analg 2003; 96:1377-1379. [PMID: 12707137 DOI: 10.1213/01.ane.0000063923.87560.37] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ashraf S Habib
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
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Ay B, Fak AS, Toprak A, Göğüş YF, Oktay A. QT dispersion increases during intubation in patients with coronary artery disease. J Electrocardiol 2003; 36:99-104. [PMID: 12764691 DOI: 10.1054/jelc.2003.50017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Anesthetic drugs have been shown to increase QT interval, however data regarding their effects on QT dispersion (QTd) are scarce, especially in patients with coronary artery disease (CAD). We tested whether induction of Anesthesia with thiopental and etomidate would increase QTd in patients with CAD. Thirty American Society of Anesthesiologists (ASA) physical status I-II patients without CAD were randomly allocated to groups I (n = 15) and II (n = 15) and 30 ASA physical status III patients with CAD were randomly allocated to groups III (n = 15) and IV (n=15). Anesthesia was induced with thiopental 5-7 mg/kg IV in groups I and III and with etomidate 0.2-0.3 mg/kg IV in groups II and IV. Endotracheal intubation was facilitated with vecuronium bromide 0.1 mg/kg IV. Twelve-lead electrocardiogram (ECG) was recorded in all patients at baseline (ECG(1)), 1 min after the induction agent (ECG(2)), 1 min (ECG(3)) and 5 min (ECG(4)) after intubation. Anesthesia was maintained with isoflurane and nitrous oxide in 34 % oxygen after ECG(2) recording. QTd and corrected QT dispersion (QTcd) were calculated. In patients with CAD induced with thiopental, QT dispersion increased significantly during the intubation period compared with baseline (from 43.0 +/- 25.6 ms to 69.2 +/- 25.3 ms; P <.01). Likewise, QT dispersion also increased during intubation in patients with CAD induced with etomidate (from 41.5 +/- 17.2 ms to 80.0 +/- 33.6 ms; P <.001). There was no increase in QT dispersion in patients without known CAD. QT dispersion seems to be increased during the intubation period in patients with CAD regardless of the induction agents used.
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Affiliation(s)
- Binnaz Ay
- Department of Anaesthesiology, Marmara University Medical School, Istanbul, Turkey.
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Affiliation(s)
- P D Booker
- Cardiac Unit, Royal Liverpool Children's Hospital, Eaton Road, Liverpool L12 2AP, UK.
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Zhou S, Cao JM, Ohara T, KenKnight BH, Chen LS, Karagueuzian HS, Chen PS. Torsade de pointes and sudden death induced by thiopental and isoflurane anesthesia in dogs with cardiac electrical remodeling. J Cardiovasc Pharmacol Ther 2002; 7:39-43. [PMID: 12000977 DOI: 10.1177/107424840200700i106] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many anesthetic agents are known to have cardiac effects. The effects of pentobarbital, thiopental and isoflurane on dogs with electrical remodeling are lacking. METHODS AND RESULTS We studied 12 dogs that underwent two anesthesias. First, anesthesia was induced (N=12) with intravenous thiopental (17 mg/kg) induction followed by isoflurane inhalation (1.5%-3% via endotracheal tube). For electrical remodeling, we created complete atrioventricular block (CAVB) and myocardial infarction (MI). In 6 of the 12 dogs we also infused nerve growth factor (NGF) to the right stellate ganglion. All dogs had an implantable cardioverter-defibrillator (ICD) implanted. A second anesthesia was done 66 +/- 20 days later. In 8 of the 12 dogs (6 without NGF), pentobarbital was used as the only anesthetic. In the remaining 4 dogs (all with NGF), 3 received thiopental and 1 received isoflurane. RESULTS During the first anesthesia, none of 12 dogs had cardiac arrhythmia. During the second anesthesia, none of the 8 dogs that received pentobarbital developed ventricular fibrillation (VF). In contrast, all the dogs receiving either thiopental or isoflurane died of VF within 2 to 3 minutes. QT and P-P intervals before VF were 440 +/- 36 milliseconds and 298 +/- 28 milliseconds, longer and shorter (respectively) than those obtained the day prior to surgery (315 +/- 25 milliseconds, P < 0.001; 330 +/- 22 milliseconds, P < 0.01, respectively). CONCLUSION Thiopental and isoflurane are not arrhythmogenic in normal dogs and dogs with acute MI and CAVB, but are extremely proarrhythmic in dogs with chronic MI and CAVB. Consistent with the results of in vitro studies, pentobarbital did not induce ventricular arrhythmia in dogs with cardiac electrical remodeling.
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Affiliation(s)
- Shengmei Zhou
- The Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, and UCLA, Los Angeles, CA, USA
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Güler N, Kati I, Demirel CB, Bilge M, Eryonucu B, Topal C. The effects of volatile anesthetics on the Q-Tc interval. J Cardiothorac Vasc Anesth 2001; 15:188-91. [PMID: 11312477 DOI: 10.1053/jcan.2001.21949] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the effects of halothane, isoflurane, and sevoflurane on Q-Tc interval (corrected for heart rate) during inhalation induction of anesthesia. DESIGN Prospective, double-blind, randomized study. SETTING Departments of Cardiology and Anesthesiology in a university hospital. PARTICIPANTS Patients undergoing noncardiac surgery. INTERVENTIONS A total of 65 American Society of Anesthesiologists physical status I-II patients, aged 16 to 50 years, undergoing general anesthesia, were randomly allocated to receive halothane, isoflurane, or sevoflurane. MEASUREMENTS AND MAIN RESULTS The time to reach the predetermined end-tidal concentrations of 3 minimum alveolar concentration was 6 to 10 minutes. When compared with preinduction values, heart rate decreased after halothane (p < 0.01) and sevoflurane (p < 0.05) administration; in contrast, heart rate increased after induction of anesthesia with isoflurane (p < 0.05). The mean QRS intervals were not significantly changed after halothane, isoflurane, or sevoflurane. The Q-Tc interval was increased with isoflurane compared with baseline (465 +/- 23 v 441 +/- 18 msec, p < 0.01), not changed with sevoflurane (441 +/- 17 v 434 +/- 19 ms, p > 0.05), and shortened with halothane (426 +/- 23 v 445 +/- 21 msec, p < 0.01). CONCLUSION Sevoflurane or halothane may be preferred to isoflurane in patients with conditions that are known to induce a prolonged Q-Tc interval. The effects of Q-Tc interval changes resulting from different anesthetic agents on morbidity and the incidence of arrhythmias during anesthesia warrant further investigation.
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Affiliation(s)
- N Güler
- Department of Cardiology, School of Medicine Yüzüncü Yil University, Van, Turkey.
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Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F. Reversing sevoflurane-associated Q-Tc prolongation by changing to propofol. Anaesthesia 2001; 56:248-50. [PMID: 11251432 DOI: 10.1046/j.1365-2044.2001.01717.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Congenital or acquired forms of the long Q-T syndrome may result in ventricular tachycardia known as torsade de pointes. Many drugs including volatile anaesthetics modify the Q-T interval. Sevoflurane is known to prolong of the rate-corrected Q-T interval (Q-Tc). The objective of this study was to determine whether the sevoflurane-associated Q-Tc prolongation is rapidly reversible when propofol is substituted for sevoflurane. Thirty-two female patients were allocated to two groups. All patients received sevoflurane induction and anaesthesia for 15 min. In one group, sevoflurane was then discontinued and anaesthesia maintained on propofol for another 15 min. The second group received sevoflurane anaesthesia for 30 min. Measurements were taken before, and 15, 20, 25 and 30 min after induction. Q-Tc prolongation was significantly reduced 5, 10 and 15 min after propofol had been substituted for sevoflurane. We conclude that the sevoflurane-associated Q-Tc prolongation is fully reversible within 15 min when propofol is substituted for sevoflurane.
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Affiliation(s)
- A Kleinsasser
- Department of Anaesthesiology and Critical Care Medicine, The Leopold-Franzens University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
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Kleinsasser A, Kuenszberg E, Loeckinger A, Keller C, Hoermann C, Lindner KH, Puehringer F. Sevoflurane, but not propofol, significantly prolongs the Q-T interval. Anesth Analg 2000; 90:25-7. [PMID: 10624970 DOI: 10.1097/00000539-200001000-00006] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED Prolongation of the Q-T interval may be associated with polymorphic ventricular tachycardia known as torsade de pointes, syncope and sudden death. Existing data show that isoflurane prolongs the Q-T interval, whereas halothane shortens it. The aim of this study was to determine whether sevoflurane or propofol affects the Q-T interval. Thirty female patients undergoing gynecologic surgery were randomly assigned to two groups, one receiving inhaled induction with sevoflurane and the other receiving total IV anesthesia with propofol. Before and 20 min after the induction, a six-lead electrocardiogram was recorded, and blood pressure was measured. The Q-T interval and heart rate adjusted Q-T interval (Q-Tc interval) were significantly prolonged during the administration of anesthesia with sevoflurane, while the Q-T interval was significantly shortened, and the Q-Tc interval was statistically unaffected during propofol anesthesia administration. We conclude that, in otherwise healthy female patients, sevoflurane prolongs the Q-Tc. IMPLICATIONS In this study, we evaluated the effect of sevoflurane induction and anesthesia versus propofol induction and anesthesia on the Q-T interval. Sevoflurane significantly prolonged the Q-T interval and the heart rate adjusted Q-T interval, whereas propofol shortened the Q-T interval but not the heart rate adjusted Q-T interval.
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Affiliation(s)
- A Kleinsasser
- Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens-University of Innsbruck, Austria.
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Michaloudis D, Fraidakis O, Lefaki T, Kanakoudis F, Askitopoulou H. Anaesthesia and the QT interval in humans: effects of halothane and isoflurane in premedicated children. Ugeskr Laeger 1998; 15:623-8. [PMID: 9884845 DOI: 10.1097/00003643-199811000-00001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The effects of halothane and isoflurane followed by subsequent administration of vecuronium on the QT interval have been investigated during the induction of anaesthesia. Fifty-eight children, ASA I, without cardiovascular and electrolyte abnormalities and not receiving any medication were studied. Anaesthesia was induced with either halothane (n = 28) or isoflurane (n = 30), and was maintained until the end of the study with end-tidal concentrations of 2.5-3%. Recordings of ECG, heart rate and systolic arterial pressure were obtained at the following times: prior to induction of anaesthesia; 1 and 3 min after stable end-tidal concentrations of the induction agent had been reached; 1 and 3 min following vecuronium administration; at the time of tracheal intubation; 1 and 3 min later. Halothane significantly shortened the QTc interval (P < 0.05); isoflurane prolonged it (P < 0.001). Heart rate decreased significantly after halothane administration (P < 0.01); in contrast, heart rate increased after induction of anaesthesia with isoflurane (P < 0.05), increasing further after laryngoscopy and tracheal intubation (P < 0.001). Systolic arterial pressure decreased significantly (P < 0.001) in both groups after induction of anaesthesia and remained decreased until the end of the study. It is concluded that halothane may be a better choice than isoflurane for children with a long QT interval.
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Affiliation(s)
- D Michaloudis
- Anaesthetic Department, University Hospital, Crete, Greece
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Michaloudis D, Fraidakis O, Petrou A, Gigourtsi C, Parthenakis F. Anaesthesia and the QT interval. Effects of isoflurane and halothane in unpremedicated children. Anaesthesia 1998; 53:435-9. [PMID: 9659015 DOI: 10.1046/j.1365-2044.1998.00376.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The effects of isoflurane and halothane on the QT interval were investigated during induction of anaesthesia. Fifty-one unpremedicated, ASA grade 1 children were studied. Anaesthesia was induced with either isoflurane (n = 25) or halothane (n = 26) and was maintained to the end of the study with end-tidal concentrations of between 2.5% and 3%. Recording of the electrocardiograph, heart rate and systolic arterial pressure were obtained at the following times: before induction of anaesthesia; 1 min and 3 min after stable end-tidal concentrations of anaesthetic agent had been reached; 1 min and 3 min following vecuronium administration; at the time of tracheal intubation and 1 min and 3 min later. Isoflurane significantly prolonged the QT interval (p < 0.001), in contrast to halothane which shortened it (p < 0.01). Heart rate remained largely unchanged during isoflurane anaesthesia but it decreased in the presence of halothane (p < 0.001). In both groups, systolic arterial pressure decreased significantly after induction of anaesthesia (p < 0.001) and remained so to the end of the study. In the isoflurane group, 12 children developed ECG repolarisation abnormalities and in one child an arrhythmia was noticed. In the halothane group, one child developed repolarisation changes while arrhythmias were observed in 10 children. There were no adverse sequelae. It is concluded that halothane may be a better anaesthetic agent than isoflurane for use in children with a prolonged QT interval.
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Affiliation(s)
- D Michaloudis
- Anaesthesiology Department, University Hospital, Iraklion, Crete, Greece
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