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Anesthesia induction regimens may affect QT interval in cardiac surgery patients: A randomized-controlled trial. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:354-362. [PMID: 36303704 PMCID: PMC9580297 DOI: 10.5606/tgkdc.dergisi.2022.23321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/15/2022] [Indexed: 11/21/2022]
Abstract
Background: The aim of this study was to investigate the effects on QT interval of the propofol-ketamine combination and the midazolam-fentanyl combination in anesthesia induction for cardiac surgery.
Methods: Between September 2020 and June 2021, a total of 9 5 c ardiac s urgery p atients ( 80 m ales, 1 5 f emales; mean age: 57±9.1 years; range, 26 to 76 years) were included. The patients were divided into two groups as Group PK (propofol-ketamine, n=50) and Group MF (midazolam-fentanyl, n=45). The 12-lead electrocardiographic and hemodynamic measurements were performed at three time points: before anesthesia induction, after anesthesia induction, and after endotracheal intubation. The measurements were evaluated with conventional Bazett's formula and a new model called index of cardio-electrophysiological balance.
Results: The evaluated QTc values of 95 patients after anesthesia induction were significantly prolonged with the Bazett's formula and the index of cardio-electrophysiological balance in Group PK (p=0.034 and p=0.003, respectively). A statistically significant QTc prolongation was observed with the index of cardio-electrophysiological balance after laryngoscopy and endotracheal intubation in Group PK (p=0.042). Hemodynamic parameters were also higher in Group PK.
Conclusion: Our study shows that the propofol-ketamine combination prolongs the QTc value determined by the Bazett's formula and the index of cardio-electrophysiological balance model. Using both QTc measurement models, the midazolam-fentanyl combination has no prolongation effect on QTc interval in coronary surgery patients.
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Gokalp G, Ozbeyaz NB. The impact of midazolam used in cataract surgery sedation on frontal QRS-T angle. J Clin Pharm Ther 2022; 47:1644-1649. [PMID: 35764598 DOI: 10.1111/jcpt.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/04/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Midazolam is one of the most commonly used drugs in procedures requiring sedoanalgesia. It affects the myocardium's ventricular depolarization and repolarization. Previous studies examining the arrhythmogenic effects of midazolam yielded conclusive results. These studies are based on QT and Tp -e distances. The frontal QRS-T angle (f-[QRS-T]a) is a new electro cardiac parameter that shows the heterogeneity of ventricular electrical activity. This study aims to examine the effect of midazolam on f-(QRS- T)a and other depolarization-repolarization parameters in patients who have had cataract surgery. METHODS The study included 177 patients administered midazolam as a sedoanalgesia during cataract surgery. The sedative effect was evaluated 2-3 minutes after a 0.05 mg/kg dose of midazolam was given. Sedation was assessed again by giving 0.5 mg every 2-3 minutes until the desired level of sedation was achieved. 12-lead electrocardiogram (ECG) recordings of all patients were taken just before and immediately after surgery. ECGs were used to calculate the QT interval, QTc interval, Tp -e interval, Tp -e/QT, Tp -e/ QTc ratios and f-(QRS-T)a. RESULTS AND DISCUSSION After cataract surgery, f-(QRS-T)a was unchanged compared to presurgery (29.14 ± 4.52 vs. 29.18 ± 5.39, p = 0.852). In addition, no significant change in QT(351.32 ± 21.98 vs. 351.94 ± 22.44, p = 0.091), QTc (384.05 ± 24.52 vs. 385.19 ± 26.12, p = 0.819), Tp -e interval (93.12 ± 9.60 vs. 94.44 ± 8.82, p = 0.179) and Tp -e/QT (0.27 ± 0.02 vs. 0.28 ± 0.03, p = 0.664), Tp -e/ QTc ratios (0.28 ± 0.02 vs. 0.29 ± 0.03, p = 0.655) was observed after surgery when compared to presurgery values. Significant ventricular and supraventricular arrhythmias were not observed in any patient during the operation. WHAT IS NEW AND CONCLUSION Midazolam did not affect f -(QRS-T) with classical repolarization parameters in patients who underwent cataract surgery, according to this study. Midazolam has been found to be safe for the heart in sedoanalgesia. These results show that sedation with midazolam can be performed without electrocardiogram monitoring.
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Affiliation(s)
- Gokhan Gokalp
- Department of Cardiology, Pursaklar State Hospital, Ankara, Turkey
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3
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Prevention and Management of Perioperative Dysrhythmias. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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4
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Effects of opioid receptor agonist and antagonist medications on electrocardiogram changes and presentation of cardiac arrhythmia: review article. J Interv Card Electrophysiol 2021; 63:471-500. [PMID: 34674120 DOI: 10.1007/s10840-021-01072-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Mortality associated with prescription opioids has significantly increased over the past few decades and is considered a global pandemic. Prescribed opioids can cause cardiac arrhythmias, leading to fatal outcomes and unexpected death, even in the absence of structural cardiac disease. Despite the extent of cardiac toxicity and death associated with these medications, there is limited data to suggest their influences on cardiac electrophysiology and arrhythmias, with the exception of methadone. The goal of our review is to describe the possible mechanisms and to review the different ECG changes and arrhythmias that have been reported. METHODS A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct to identify studies that demonstrated the use of prescription opioids leading to electrocardiogram (ECG) changes and cardiac arrhythmias. RESULTS Many of the commonly prescribed opioid medications can uniquely effect the ECG, and can lead to the development of various cardiac arrhythmias. One of the most significant side effects of these drugs is QTc interval prolongation, especially when administered to patients with a baseline risk for QTc prolongation. A prolonged QTc interval can cause lethal torsades de pointes and ventricular fibrillation. Obtaining an ECG at baseline, following a dosage increase, or after switching an opioid medication, is appropriate in patients taking certain prescribed opioids. Opioids are often used first line for the treatment of acute and chronic pain, procedural sedation, medication opioid use disorders, and maintenance therapy. CONCLUSIONS To reduce the risk of cardiac arrhythmias and to improve patient outcomes, consideration of accurate patient selection, concomitant medications, electrolyte monitoring, and vigilant ECG monitoring should be considered.
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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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6
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Alfarih M, Moon JC, Fontana M, Knight D, Captur G. An unusual cause of polymorphic ventricular tachycardia: Acquired long QT syndrome from atypical variant of stress-induced cardiomyopathy. SAGE Open Med Case Rep 2020; 8:2050313X20944307. [PMID: 32922792 PMCID: PMC7457639 DOI: 10.1177/2050313x20944307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 11/15/2022] Open
Abstract
A 55-year-old woman with a recent history of surgically and radioiodine treated thyroid cancer experienced a run of polymorphic ventricular tachycardia with hemodynamic perturbation during anaesthetic induction with propofol, fentanyl and rocuronium for elective surgical excision of right hip metastasis. Electrocardiography showed new T-wave inversion and QT prolongation that subsequently resolved. Cardiac enzymes were elevated but invasive coronary angiography showed unobstructed epicardial coronary arteries. Cardiovascular magnetic resonance showed not only normal biventricular size and systolic function but also a striking pattern of patchy myocardial oedema involving the basal-to-mid anterior, septal and inferior walls and some associated hypertrophy in the anteroseptum (representing focal myocardial swelling from the oedema) but no focal or diffuse myocardial fibrosis. All these abnormalities resolved on subsequent convalescent imaging. A diagnosis of multifactorial acquired long QT syndrome secondary to atypical variant stress-induced cardiomyopathy was made with the likely provoking factors in this case having been the female sex, understandable pre-operative anxiety, anaesthetic drugs, supraglottic airway placement and thyroid dysfunction. An implantable loop recorder during follow-up detected no further significant arrhythmias and she remains well and asymptomatic to date on a low dose of beta-blocker.
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Affiliation(s)
- Mashael Alfarih
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Royal Free London NHS Foundation Trust, London, UK
| | - Dan Knight
- Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiovascular Magnetic Resonance, Royal Free London NHS Foundation Trust, London, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, UK.,MRC Unit for Lifelong Health and Ageing at UCL, London, UK.,Inherited Heart Muscle Conditions Unit, Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK
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7
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Pehlivan B, Akçay M, Atlas A, Erol MK, Duran E, Karahan MA, Binici O, Büyükfırat E, Altay N. Comparison of General Anesthesia (Sevoflurane) and Spinal Anesthesia (Levobupivacaine) Methods on QT Dispersion in Inguinal Hernia Operations. Cureus 2020; 12:e9079. [PMID: 32789031 PMCID: PMC7416987 DOI: 10.7759/cureus.9079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/08/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.
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Affiliation(s)
| | - Murat Akçay
- Anesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, TUR
| | - Ahmet Atlas
- Anesthesiology, Harran University, Sanliurfa, TUR
| | | | - Erdogan Duran
- Anesthesiology and Reanimation, Harran University, Sanliurfa, TUR
| | - Mahmut A Karahan
- Anesthesiology and Critical Care, Harran University, Sanliurfa, TUR
| | - Orhan Binici
- Anesthesiology and Critical Care, Harran University, Sanliurfa, TUR
| | - Evren Büyükfırat
- Anesthesiology and Critical Care, Harran University, Sanliurfa, TUR
| | - Nuray Altay
- Anesthesiology and Critical Care, Harran University, Sanliurfa, TUR
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8
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Chikata A, Kato T, Usuda K, Fujita S, Maruyama M, Otowa K, Usuda K, Niwa S, Tsuda T, Hayashi K, Takamura M. Prolongation of QT interval after pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:2371-2379. [DOI: 10.1111/jce.14625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Akio Chikata
- Department of Internal Medicine, Division of Cardiology Toyama Prefectural Central Hospital Toyama Japan
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuo Usuda
- Department of Internal Medicine, Division of Cardiology Toyama Prefectural Central Hospital Toyama Japan
| | - Shuhei Fujita
- Department of Pediatrics Toyama Prefectural Central Hospital Toyama Japan
| | - Michiro Maruyama
- Department of Internal Medicine, Division of Cardiology Toyama Prefectural Central Hospital Toyama Japan
| | - Kan‐ichi Otowa
- Department of Internal Medicine, Division of Cardiology Toyama Prefectural Central Hospital Toyama Japan
| | - Keisuke Usuda
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Satoru Niwa
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Toyonobu Tsuda
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine Kanazawa University Graduate School of Medical Science Kanazawa Japan
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Abstract
Ventricular arrhythmias are associated with significant morbidity and mortality. In the perioperative period, more than 10% of patients undergoing a general anesthetic have an abnormal heart rhythm. Arrhythmia development is a dynamic interplay between an arrhythmogenic substrate, myocardial electrophysiologic properties, modifying factors, and triggering factors. Imbalances in the autonomic nervous system can lead to increased myocardial excitability, which is a major contributor to the pathophysiology of ventricular tachyarrhythmias. Myocardial excitability and ventricular arrhythmogenesis is modulated perioperatively through hemodynamic management, electrolyte balance, anesthetic agents, or regional anesthetic and surgical techniques.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Yuki Kuwabara
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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10
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Tascanov MB, Tanriverdi Z, Gungoren F, Besli F, Bicer Yesilay A, Altiparmak HI, Bayram G, Demir K. The effect of propofol on frontal QRS‐T angle in patients undergoing elective colonoscopy procedure. J Clin Pharm Ther 2019; 45:185-190. [DOI: 10.1111/jcpt.13055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/09/2019] [Accepted: 08/23/2019] [Indexed: 01/18/2023]
Affiliation(s)
| | - Zulkif Tanriverdi
- Department of Cardiology Faculty of Medicine Harran University Sanliurfa Turkey
| | - Fatih Gungoren
- Department of Cardiology Faculty of Medicine Harran University Sanliurfa Turkey
| | - Feyzullah Besli
- Department of Cardiology Faculty of Medicine Harran University Sanliurfa Turkey
| | | | | | - Gursel Bayram
- Department of Gastroentrology Tokat Medical Park Hospital Tokat Turkey
| | - Kadir Demir
- Department of Anesthesia Tokat State Hospital Tokat Turkey
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11
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Demirhan A, Velioglu Y, Yoldas H, Karagoz I, Cosgun M, Caliskan D, Yildiz I, Bilgi M, Erdem K. An Easy and Reliable Way to Prevent Electrocardiographic Deteriorations of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: Preoperative Anxiolytic Treatment. Braz J Cardiovasc Surg 2019; 34:311-317. [PMID: 31310470 PMCID: PMC6629217 DOI: 10.21470/1678-9741-2018-0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. METHODS A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. RESULTS Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). CONCLUSION Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.
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Affiliation(s)
- Abdullah Demirhan
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Yusuf Velioglu
- Abant Izzet Baysal University Medical School Bolu Turkey Department of Cardiovascular Surgery, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Hamit Yoldas
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Ibrahim Karagoz
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Mehmet Cosgun
- Abant Izzet Baysal University Medical School Department of Cardiology Bolu Turkey Department of Cardiology, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Duygu Caliskan
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Isa Yildiz
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Murat Bilgi
- Abant Izzet Baysal University Medical School Department of Anesthesiology and Reanimation Bolu Turkey Department of Anesthesiology and Reanimation, Abant Izzet Baysal University Medical School, Bolu, Turkey
| | - Kemalettin Erdem
- Abant Izzet Baysal University Medical School Bolu Turkey Department of Cardiovascular Surgery, Abant Izzet Baysal University Medical School, Bolu, Turkey
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12
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Thiruvenkatarajan V, Lee JY, Sembu M, Watts R, Van Wijk RM. Effects of esmolol on QTc interval changes during tracheal intubation: a systematic review. BMJ Open 2019; 9:e028111. [PMID: 31023764 PMCID: PMC6501987 DOI: 10.1136/bmjopen-2018-028111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION AND AIMS Esmolol is an ultra-short-acting β1 antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI. MATERIALS AND METHODS PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension. RESULTS Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted. CONCLUSION Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval). TRIAL REGISTRATION NUMBER CRD42018090282.
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Affiliation(s)
| | - Jenn Yuan Lee
- The University of Adelaide, Adelaide, South Australia, Australia
| | - Manesha Sembu
- University of New South Wales, Sydney, New South Wales, Australia
| | - Richard Watts
- Anaesthesia, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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13
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Colak F, Ozgul U, Erdogan MA, Kayhan GE, Erdil FA, Çolak C, Durmus M. Comparison of hemodynamic responses and QTc intervals to tracheal intubation with the McGRATH MAC videolaryngoscope and the Macintosh direct laryngoscope in elderly patients. Kaohsiung J Med Sci 2019; 35:116-122. [PMID: 30848023 DOI: 10.1002/kjm2.12017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/22/2018] [Indexed: 11/09/2022] Open
Abstract
Our hypothesis was that intubations with the McGRATH MAC videolaryngoscope in elderly patients would produce less hemodynamic responses and ECG changes than the Macintosh direct laryngoscope. The patients were divided into two groups: patients who were intubated using the McGRATH MAC (Group V, n = 45) and patients who were intubated using the Macintosh direct laryngoscope (Group L, n = 45). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), heart rate (HR) were recorded before induction with anesthesia (baseline), immediately after induction and at 1 min, 3 min, and 5 min after intubation, with simultaneous ECG. When Group L was compared to Group V, there was an increase in the first, third and fitth minutes after intubation in terms of HR. SBP, MAP increased only at 1 min after intubation and DBP increased in the first and third minutes after intubation in Group L. In Group L, there was a significant difference in the HR values immediately after induction and the first minute after intubation compared with the baseline values. There was a difference in the SBP values immediately after induction and at 3 min and 5 min after intubation compared with the baseline values. There was a difference in DBP and MAP values immediately after induction and at 5 min after intubation. When the McGRATH MAC videolaryngoscope was compared with the Macintosh direct laryngoscope in elderly patients, the McGRATH MAC videolaryngoscope decreased the hemodynamic fluctuations due to tracheal intubation.
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Affiliation(s)
- Fatih Colak
- Department of Anaesthesiology, Siverek State Hospital, Malatya, Turkey
| | - Ulku Ozgul
- Department of Anaesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Mehmet A Erdogan
- Department of Anaesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Gulay E Kayhan
- Department of Anaesthesiology and Reanimation, Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Feray A Erdil
- Department of Anaesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
| | - Cemil Çolak
- Department of Biostatistics, and Medical Informatics, Inonu University, School of Medicine, Malatya, Turkey
| | - Mahmut Durmus
- Department of Anaesthesiology and Reanimation, Inonu University, School of Medicine, Malatya, Turkey
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14
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Bialka S, Jaroszynski A, Schlegel TT, Misiolek H, Czyzewski D, Sawicki M, Skoczylas P, Bielacz M, Bialy M, Szarpak L, Dabrowski W. Elective lung resection increases spatial QRS-T angle and QTc interval. Cardiol J 2018; 27:705-714. [PMID: 30575004 DOI: 10.5603/cj.a2018.0159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/25/2018] [Accepted: 11/28/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Lung resection changes intra-thoracic anatomy, which may affect electrocardiographic results. While postoperative cardiac arrhythmias have been recognized after lung resection, no study has documented changes in vectorcardiographic variables in patients undergoing this surgery. The purpose of this study was to analyse changes in spatial QRS-T angle (spQRS-T) and corrected QT interval (QTc) after lung resection. METHODS Adult patients undergoing elective lung resection under general anaesthesia were studied. The patients were allocated into four groups: those undergoing (1) left lobectomy (LL); (2) left pneumonectomy (LP); (3) right lobectomy (RL); and (4) right pneumonectomy (RP). The spQRS-T angle and QTc interval were measured one day before surgery (baseline) and 24, 48 and 72 h after surgery. RESULTS Seventy-one adult patients (47 men and 24 women) aged 47-80 (65 ± 7) years were studied. In the study group as a whole, lung resection was associated with significant increases in spQRS-T (p < 0.001) and QTc (p < 0.05 at 24 and 48 h and p < 0.01 at 72 h). The greatest changes were noted in patients undergoing LP. Postoperative atrial fibrillation (AF) was noted in 6.4% of patients studied, in whom the widest spQRS-T angle and the most prolonged QTc intervals were also noted. CONCLUSIONS Lung resection widens the spQRS-T angle and prolongs the QTc interval, especially in patients undergoing LP. While postoperative AF was a relatively rare complication after lung resection in this study, it was associated with the widest spQRS-T angles and most prolonged QTc intervals.
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Affiliation(s)
- Szymon Bialka
- Department of Anaesthesiology and Intensive Therapy, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Andrzej Jaroszynski
- Department of Nephrology, Institute of Medical Science, Jan Kochanowski University of Kielce, Poland
| | - Todd T Schlegel
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden, and Nicollier-Schlegel SARL, Trélex, Switzerland
| | - Hanna Misiolek
- Department of Anaesthesiology and Intensive Therapy, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Damian Czyzewski
- Department of Thoracic Surgery School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Katowice
| | - Marek Sawicki
- Department of Thoracic Surgery Medical University of Lublin, Poland
| | - Piotr Skoczylas
- Department of Thoracic Surgery Medical University of Lublin, Poland
| | - Magdalena Bielacz
- Institute of Tourism and Recreation, State Vocational College of Szymon Szymonowicz, Zamosc, Poland
| | - Mateusz Bialy
- Department of Anaesthesiology and Intensive Therapy Medical University of Lublin, Poland, Lublin, Poland
| | | | - Wojciech Dabrowski
- Department of Anaesthesiology and Intensive Therapy Medical University of Lublin, Poland, Lublin, Poland.
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Behzadi M, Joukar S, Beik A. Opioids and Cardiac Arrhythmia: A Literature Review. Med Princ Pract 2018; 27:401-414. [PMID: 30071529 PMCID: PMC6244110 DOI: 10.1159/000492616] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 08/02/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability. METHODS By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions. RESULTS Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation. CONCLUSION The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.
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Affiliation(s)
- Mina Behzadi
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences and Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Siyavash Joukar
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences and Department of Physiology and Pharmacology, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Beik
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Tominaga S, Terao Y, Urabe S, Ono M, Oji N, Oji M, Fukusaki M, Hara T. The effects of intravenous anesthetics on QT interval during anesthetic induction with desflurane. JA Clin Rep 2018; 4:57. [PMID: 32025881 PMCID: PMC6967065 DOI: 10.1186/s40981-018-0195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aimed to determine the effects of the interaction between intravenous anesthetics and desflurane on the QT interval. Methods Fifty patients who underwent lumbar spine surgery were included. The patients received 3 μg/kg fentanyl and were randomly divided into two groups: group P patients received 1.5 mg/kg propofol and group T patients received 5 mg/kg thiamylal 2 min after fentanyl injection. All patients received rocuronium and desflurane (6% inhaled concentration) after loss of consciousness. Tracheal intubation was performed 3 min after rocuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiograms were recorded before fentanyl injection (T1), 2 min after fentanyl injection (T2), 1 min after propofol or thiamylal injection (T3), immediately before intubation (T4), and 2 min after intubation (T5). Results There were no significant intergroup differences in patient characteristics. BIS and MAP decreased after anesthesia induction in both groups. MAP values at T3, T4, and T5 in group T were higher than those in group P. HR did not change over time or differ between the groups. The QTc intervals at T4 and T5 in group T were longer than those at T1. In group P, the QTc interval at T3 was significantly shorter than that at T1. The QTc intervals at T3, T4, and T5 in group T were significantly longer than those in group P. Conclusions A propofol injection could counteract the QTc interval prolongation during desflurane anesthesia induction. Trial registration UMIN Clinical Trials Registry database reference number: UMIN000023707. This study was registered on August 21, 2016.
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Affiliation(s)
- Shozo Tominaga
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Yoshiaki Terao
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan.
| | - Shigehiko Urabe
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Maki Ono
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Natsuko Oji
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Makito Oji
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Makoto Fukusaki
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134, Japan
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Perioperative management of patients with congenital or acquired disorders of the QT interval. Br J Anaesth 2018; 120:629-644. [DOI: 10.1016/j.bja.2017.12.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/16/2017] [Accepted: 01/14/2018] [Indexed: 12/19/2022] Open
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Kamaleswaran R, Mahajan R, Akbilgic O. A robust deep convolutional neural network for the classification of abnormal cardiac rhythm using single lead electrocardiograms of variable length. Physiol Meas 2018; 39:035006. [DOI: 10.1088/1361-6579/aaaa9d] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Xuan C, Wu N, Li Y, Sun X, Zhang Q, Ma H. Corrected QT interval prolongation during anesthetic induction for laryngeal mask airway insertion with or without cisatracurium. J Int Med Res 2018; 46:1990-2000. [PMID: 29584526 PMCID: PMC5991250 DOI: 10.1177/0300060518764185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective This study was performed to observe the occurrence of corrected QT (QTc) interval prolongation during anesthetic induction for laryngeal mask airway insertion and the effects of cisatracurium administration on the QTc interval. Methods Eighty-eight patients were assigned to two groups: the cisatracurium administration group (n = 45) and non-cisatracurium administration group (n = 43). The QTc interval was continuously recorded by a 12-lead Holter electrocardiogram beginning in the hospital ward and continuing until after anesthetic induction. Results In the cisatracurium administration group, the QTc interval significantly increased from 417.9 ± 27.9 to 451.6 ± 32.5 ms after arrival in the operating room and significantly decreased to 432.4 ± 32.5 ms after a 15-minute rest; it significantly increased to 459.7 ± 23.8 ms again after propofol and fentanyl injection. However, the QTc interval decreased after cisatracurium injection. In the non-cisatracurium administration group, the QTc interval initially showed changes similar to those in the cisatracurium group until fentanyl and propofol were injected. Conclusions The QTc interval was significantly prolonged on arrival in the operating room and after propofol and fentanyl injection. The QTc interval did not significantly change by laryngeal mask airway insertion regardless of the administration of cisatracurium.
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Affiliation(s)
- Chengluan Xuan
- 1 Department of Anesthesiology, The 377382 First Hospital of Jilin University , Changchun, Jilin 130021, China
| | - Nan Wu
- 1 Department of Anesthesiology, The 377382 First Hospital of Jilin University , Changchun, Jilin 130021, China
| | - Yanhui Li
- 1 Department of Anesthesiology, The 377382 First Hospital of Jilin University , Changchun, Jilin 130021, China
| | - Xiaoting Sun
- 2 Department of Anesthesiology, Jilin Cancer Hospital, Changchun, Jilin 130021, China
| | - Qunshu Zhang
- 3 Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Haichun Ma
- 1 Department of Anesthesiology, The 377382 First Hospital of Jilin University , Changchun, Jilin 130021, China
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Cascella M. Preoperative cardiac evaluation and anesthetic considerations for cancer patients who underwent chemotherapy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Cho JS, Kim SH, Shin S, Pak HN, Yang SJ, Oh YJ. Effects of Dexmedetomidine on Changes in Heart Rate Variability and Hemodynamics During Tracheal Intubation. Am J Ther 2016; 23:e369-76. [PMID: 24832388 DOI: 10.1097/mjt.0000000000000074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sympathetic hyperactivation during tracheal intubation prolongs the QT interval and increases the risk of arrhythmias. We investigated if dexmedetomidine pretreatment affected autonomic nervous system balance and QT intervals during intubation. Sixty-six patients were randomized to receive 1.0 μg/kg fentanyl (group F, n = 22), 0.5 μg/kg dexmedetomidine (group D0.5, n = 22), or 1.0 μg/kg dexmedetomidine (group D1.0, n = 22) before induction. Autonomic nervous system balance was assessed by the ratio of low-frequency/high-frequency (LF/HF) power for heart rate variability at baseline (T0), before intubation (T1), and after intubation (T2). QT intervals were corrected by the Bazett's formula (QTc) and compared at baseline, before intubation, and 1, 2, and 3 minutes after intubation. The LF/HF ratio was higher after intubation compared with that at T0 in group F (P < 0.001). There were no significant changes in groups D0.5 and D1.0. The LF/HF ratio was significantly higher in group F compared with those in groups D0.5 and D1.0 after intubation (7.9 vs. 2.1 and 2.5; P < 0.001). The heart rate was increased for 3 minutes after intubation in group F, whereas only for 1 minute after intubation in groups D0.5 and D1.0, compared with that at baseline. More patients in group F had QTc greater than 440 ms compared with that in group D0.5 or D1.0 (8 vs. 1 and 2; P = 0.005) at 1 minute after intubation. In contrast to 1.0 μg/kg fentanyl, pretreatment with 0.5 or 1.0 μg/kg dexmedetomidine suppressed sympathetic hyperactivity and attenuated QTc prolongation during intubation.
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Affiliation(s)
- Jin Sun Cho
- Departments of 1Anesthesiology and Pain Medicine and 2Cardiology, Yonsei University College of Medicine, Seoul, Republic of Korea; and 3Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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A Comparison of the Effects of Sevoflurane and Desflurane on Corrected QT Interval Prolongation in Patients Undergoing Living Donor Liver Transplantation: A Prospective Observational Study. Transplant Proc 2016; 48:96-101. [PMID: 26915850 DOI: 10.1016/j.transproceed.2015.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 12/30/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND QT interval prolongation has frequently been observed in patients with advanced liver disease. We investigated the influence of inhalation anesthetics on the corrected QT (QTc) interval prolongation during surgery in patients undergoing living-donor liver transplantation. METHODS Our study included 43 patients who were assigned to 2 groups: sevoflurane (n = 22) or desflurane anesthesia (n = 21). QTc intervals were measured at perioperative determined time points and calculated using Fridericia's formula. RESULTS Intraoperative QTc intervals increased during the peri-intubation period versus baseline (P = .003) and were prolonged during the peri-reperfusion period (P < .001). However, there was no significant difference in intraoperative QTc interval changes between patients given sevoflurane or desflurane (P = .59). CONCLUSIONS In this prospective observational study, there was no significant difference in QTc intervals between sevoflurane and desflurane. QTc intervals increased during intubation and reperfusion relative to preoperative values in patients given either sevoflurane or desflurane.
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The effects of intravenous anesthetics on QT interval during anesthetic induction with sevoflurane. J Anesth 2016; 30:929-934. [DOI: 10.1007/s00540-016-2252-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/14/2016] [Indexed: 12/19/2022]
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Kim TK, Cho YJ, Lim CW, Min JJ, Choi EK, Hong DM, Jeon Y. Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery. BMC Anesthesiol 2016; 16:56. [PMID: 27488394 PMCID: PMC4972982 DOI: 10.1186/s12871-016-0222-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 07/15/2016] [Indexed: 02/07/2023] Open
Abstract
Background Ramosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding affinity and more prolonged duration of action compared to ondansetron. The present study was performed to evaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients undergoing cardiac surgery. Method A total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this randomised placebo-controlled trial. Patients were allocated into two groups that received intravenous injection of 0.3 mg ramosetron or normal saline during induction of anaesthesia. QTc intervals were measured before the operation, intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min after injection of ramosetron or normal saline), at the end of the operation, and on postoperative day 1. Results There were no differences in mean QTc interval between groups at every time point. However, maximal change in QTc interval during surgery was higher in the ramosetron group than the placebo group (25.1 ± 22.0 vs. 17.5 ± 14.5 ms, 95 % CI 0.34–14.78, P = 0.040). Also, there were more patients with a QTc interval increase of > 60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6–18.0, P = 0.021). There were no significant differences in cardiovascular complications. Conclusions Ramosetron administered during induction of anaesthesia may affect maximal change in QTc interval during off-pump coronary artery bypass surgery. Ramosetron should be used with caution in high risk patients for developing Torsades de Pointes. Trial registration ClinicalTrials.gov NCT02139241. Registered November 12, 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0222-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tae Kyong Kim
- Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Youn Joung Cho
- Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Chae-Won Lim
- Department of Anaesthesiology and Pain Medicine, Cheorwon Gil Hospital, Gangwon-Do, Korea
| | - Jeong Jin Min
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Deok Man Hong
- Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea
| | - Yunseok Jeon
- Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea.
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Kim NY, Han DW, Koh JC, Rha KH, Hong JH, Park JM, Kim SY. Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak-Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study. Medicine (Baltimore) 2016; 95:e3645. [PMID: 27175685 PMCID: PMC4902527 DOI: 10.1097/md.0000000000003645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak-Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position.Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO2, and end-tidal sevoflurane concentrations were assessed as well.Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (PGroup × Time = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups.Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO2 pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy.
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Affiliation(s)
- Na Young Kim
- From the Department of Anesthesiology and Pain Medicine (NYK, DWH, JCK, JMP, SYK); Anesthesia and Pain Research Institute (NYK, DWH, JCK, SYK); Department of Urology, Urological Science Institute (KHR); Department of Research Affairs, Biostatistics Collaboration Units (JHH), Yonsei University College of Medicine, Seoul, Republic of Korea
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Agámez Medina GL, González-Arévalo A, Gómez-Arnau JI, García del Valle S, Rubio JA, Esteban E, Pérez E. Effects of droperidol and ondansetron on dispersion of ventricular repolarization: A randomized double-blind clinical study in anesthetized adult patients. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2015; 62:495-501. [PMID: 25887095 DOI: 10.1016/j.redar.2015.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/28/2015] [Accepted: 01/29/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Droperidol and ondansetron prolong QT interval, a circumstance that has raised some concerns regarding the possibility of inducing torsades de pointes (TdP). However drug-induced spatial dispersion of ventricular repolarization has been shown to be the principal arrhythmogenic substrate for TdP. The aim of this study is to explore the effects of droperidol and ondansetron on the dispersion of repolarization, measured using the T peak-to-end interval (Tp-e) and Tp-e/QT and Tp-e/RR(1/2) ratios in surgical anesthetized patients. METHODS A randomized, double-blind study carried out on sixty-three adult patients without cardiac disease or factors favoring QT prolongation and undergoing non-cardiac surgery were randomly assigned to the droperidol or ondansetron group. Under propofol anesthesia, a 12-lead EKG was obtained, and 1.25mg droperidol or 4mg ondansetron was injected. Five minutes later, a new 12-lead EKG was recorded. EKG analyses were independently performed by two cardiologists blinded to the state of the traces or group allocation. QT, RR and Tp-e intervals were measured by averaging five successive beats in leadII (QT) or V5 (Tp-e). The mean value for each measurement was calculated for statistical analysis. RESULTS Thirty-two patients (19 women) received droperidol, and 31 (22 women) ondansetron. Droperidol and ondansetron prolonged the QTcF interval (Fridericia formula) by 6.8 and 7.2ms (mean values) respectively, but neither droperidol nor ondansetron increased the Tp-e interval or Tp-e/QT and Tp-e/RR(1/2) ratios. CONCLUSION At antiemetic doses, neither ondansetron (4mg) nor droperidol (1.25mg) increases the dispersion of ventricular repolarization in healthy adult patients anesthetized with propofol.
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Affiliation(s)
- G L Agámez Medina
- Departamento de Anestesiología y Reanimación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - A González-Arévalo
- Departamento de Anestesiología y Reanimación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J I Gómez-Arnau
- Departamento de Anestesiología y Reanimación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - S García del Valle
- Departamento de Anestesiología y Reanimación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - J A Rubio
- Unidad de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E Esteban
- Unidad de Cardiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - E Pérez
- Research Institute, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Sex-related differences in the effect-site concentration of remifentanil for preventing QTc interval prolongation following intubation in elderly patients with a normal QTc interval. Drugs Aging 2015; 31:695-702. [PMID: 24989629 DOI: 10.1007/s40266-014-0198-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Female sex and age more than 65 years are common risk factors for the development of torsades de pointes in association with heart rate-corrected QT (QTc) interval prolongation, which can be induced by tracheal intubation during general anaesthesia. However, the administration of remifentanil can prevent intubation-induced QTc interval prolongation. We compared sex-related differences in the effect-site concentration (Ce) of remifentanil for preventing QTc interval prolongation among elderly patients. METHODS Twenty-two female and 22 male patients older than 65 years were enrolled. Anaesthesia was induced with remifentanil and propofol using a target-controlled infusion. The Ce of remifentanil for maintaining a QTc interval prolongation <15 ms following intubation was determined for each sex using the isotonic regression method and a bootstrapping approach following Dixon's up-and-down method. RESULTS The Ce of remifentanil for preventing QTc interval prolongation following intubation in 50 % of the population (EC50) and 95 % of the population (EC95) were significantly lower in females than in males. Isotonic regression revealed that the EC50 (83 % confidence interval) of remifentanil was 3.50 (2.95-4.08) ng/mL in females and 4.38 (4.08-4.63) ng/mL in males. The EC95 (95 % confidence interval) of remifentanil was 4.43 (4.25-4.48) ng/mL in females and 4.94 (4.78-4.98) ng/mL in males. CONCLUSIONS Target-controlled infusion of remifentanil is effective in attenuating QTc interval prolongation after intubation among elderly patients and the Ce of remifentanil is lower in females than in males.
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Ağdanlı D, Öztürk T, Ütük O, Keleş GT. Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery. Turk J Anaesthesiol Reanim 2014; 42:245-50. [PMID: 27366430 DOI: 10.5152/tjar.2014.64326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 10/21/2013] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Existing myocardial damage in coronary artery disease patients causes prolonged QT syndrome. The primary objective of this trial is to explore the effects of different doses of the muscle relaxant agent rocuronium (0.6 mg kg(-1) and 1.2 mg kg(-1)) on QTc following anaesthetic induction. The second objective is to determine the incidence and kinds of arrhythmias. METHODS In this prospective and randomized trial, patients undergoing elective coronary artery revascularization surgery were included in one of two groups. Both groups took the same anaesthetic induction agents: midazolam and fentanyl. Rocuronium was administered in Group 1 (n=20) with dose of 0.6 mg kg(-1) and in Group 2 (n=20) with a dose of 1.2 mg kg(-1) for muscle relaxation. Heart rate, average arterial pressure and QTc were recorded before induction (T0), after induction (T1), after muscle relaxant (T2), and 2 minutes (T3) and 5 minutes after intubation (T4). RESULTS QTc was significantly longer 2 minutes after intubation (in Group 1 and Group 2, respectively, 447.9±28.3 and 466.1±37.8 ms) than at the beginning (respectively, 426.9±25.7, 432.0±35.5 ms) (p<0.01). In the intergroup comparison, average QTc values were similar in all trial periods (p>0.05). The prevalence of arrhythmias in between Group 1 (35%, n=7) and Group 2 (15%, n=3) was similar (p=0.06). Arrhythmias were recorded 2 minutes after intubation in both groups (n=10, 25%). CONCLUSION In patients undergoing coronary artery revascularization surgery, rocuronium doses of 0.6 mg kg(-1) and 1.2 mg kg(-1) prolong the QTc interval after intubation. Cardiac arrhythmias related to long QTc arising after intubation should be taken into consideration.
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Affiliation(s)
- Doğuş Ağdanlı
- Clinic of Anaesthesiology, Van İpekyolu State Hospital, Van, Turkey
| | - Tülün Öztürk
- Department of Anaesthesiology and Reanimation, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ozan Ütük
- Clinic of Cardiology, Grandmedical Hospital, Manisa, Turkey
| | - Gönül Tezcan Keleş
- Department of Anaesthesiology and Reanimation, Celal Bayar University Faculty of Medicine, Manisa, Turkey
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SHIN S, LEE JW, KIM SH, JUNG YS, OH YJ. Heart rate variability dynamics during controlled hypotension with nicardipine, remifentanil and dexmedetomidine. Acta Anaesthesiol Scand 2014; 58:168-76. [PMID: 24261345 DOI: 10.1111/aas.12233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was done to investigate how nicardipine, remifentanil and dexmedetomidine affect the balance of the autonomic nervous system in patients receiving controlled hypotension under general anaesthesia by evaluating heart rate variability indices. METHODS Sixty-two patients were randomly allocated to either the nicardipine-sevoflurane (Group N, n = 21), remifentanil-sevoflurane (Group R, n = 21) or dexmedetomidine-sevoflurane (Group D, n = 20) group for controlled hypotension during orthognathic surgery. Electrocardiogram data acquisition was done after vital sign stabilization following anaesthesia induction (T1) and 30 min after controlled hypotension was induced (T2). RESULTS Total power and low frequency (LF) power was significantly decreased at T2 compared with T1 in all groups, while a decrease in high frequency (HF) power was only observed in Group N (P < 0.001). LF/HF ratios of Group R and D were significantly suppressed at T2 compared with T1 (P = 0.001 and P < 0.001, respectively), but was increased Group N (P = 0.009). The LF/HF ratio of Group N was significantly higher than Group R and D at T2 (P < 0.001 in both), with Group D showing a significantly lower LF/HF ratio compared with Group R (P < 0.001). CONCLUSIONS Remifentanil and dexmedetomidine did not have sympathetic nervous system-stimulating effects during controlled hypotension, while remifentanil seemed to be superior in preserving the overall balance in autonomic nervous system activity. Nicardipine was found to stimulate the sympathetic nervous system, which may be problematic in patients vulnerable to disturbances in the autonomic nervous system.
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Affiliation(s)
- S. SHIN
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - J. W. LEE
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - S. H. KIM
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
| | - Y.-S. JUNG
- Department of Oral and Maxillofacial Surgery; Yonsei University College of Dentistry; Seoul Korea
| | - Y. J. OH
- Department of Anesthesiology and Pain Medicine; Anesthesia and Pain Research Institute; Yonsei University College of Medicine; Seoul Korea
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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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Dogan Z, Yildiz H, Akcay A, Coskuner I, Arikan DC, Silay E, Akbudak IH, Kaya H, Oksuz H. The Effect of Intraspinal BupivacaineversusLevobupivacaine on the QTc Intervals during Caesarean Section: A Randomized, Double-blind, Prospective Study. Basic Clin Pharmacol Toxicol 2013; 114:248-53. [DOI: 10.1111/bcpt.12146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Zafer Dogan
- Department of Anesthesiology; Faculty of Medicine; Bezmialem Vakif University; Istanbul Turkey
| | - Huseyin Yildiz
- Department of Anesthesiology; Faculty of Medicine; Sutcu Imam University; Kahramanmaras Turkey
| | - Ahmet Akcay
- Department of Cardiology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras Turkey
| | - Ismail Coskuner
- Department of Anesthesiology; Faculty of Medicine; Sutcu Imam University; Kahramanmaras Turkey
| | - Deniz C. Arikan
- Department of Gynecology and Obstetrics; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras Turkey
| | - Emin Silay
- Department of Anesthesiology; Faculty of Medicine; Sutcu Imam University; Kahramanmaras Turkey
| | - Ilknur H. Akbudak
- Department of Anesthesiology; Faculty of Medicine; Sutcu Imam University; Kahramanmaras Turkey
| | - Hakan Kaya
- Department of Cardiology; Faculty of Medicine; Kahramanmaras Sutcu Imam University; Kahramanmaras Turkey
| | - Hafize Oksuz
- Department of Anesthesiology; Faculty of Medicine; Sutcu Imam University; Kahramanmaras Turkey
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de Kam PJ, Grobara P, Dennie J, Cammu G, Ramael S, Jagt-Smook MLF, van den Heuvel MW, Berg RJW, Peeters PAM. Effect of Sugammadex on QT/QTc Interval Prolongation when Combined with QTc-Prolonging Sevoflurane or Propofol Anaesthesia. Clin Drug Investig 2013; 33:545-51. [DOI: 10.1007/s40261-013-0095-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Edson E, Chen L, Augoustides JG. Trigger-free anesthetic management in congenital long QT syndrome. J Clin Anesth 2013; 25:345-7. [DOI: 10.1016/j.jclinane.2013.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/25/2012] [Accepted: 01/17/2013] [Indexed: 10/26/2022]
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Toyoda T, Terao Y, Oji M, Okada M, Fukusaki M, Sumikawa K. The interaction of antiemetic dose of droperidol with propofol on QT interval during anesthetic induction. J Anesth 2013; 27:885-9. [DOI: 10.1007/s00540-013-1625-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
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Effects of esmolol, lidocaine and fentanyl on P wave dispersion, QT, QTc intervals and hemodynamic responses to endotracheal intubation during propofol induction: a comparative study. Rev Bras Anestesiol 2013; 63:235-44. [DOI: 10.1016/s0034-7094(13)70223-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 03/03/2012] [Indexed: 11/30/2022] Open
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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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Oji M, Terao Y, Toyoda T, Kuriyama T, Miura K, Fukusaki M, Sumikawa K. Differential effects of propofol and sevoflurane on QT interval during anesthetic induction. J Clin Monit Comput 2012; 27:243-8. [PMID: 23242843 DOI: 10.1007/s10877-012-9420-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 12/07/2012] [Indexed: 11/30/2022]
Abstract
There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.
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Affiliation(s)
- Makito Oji
- Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo 857-0134, Japan
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Raffa RB, Burmeister JJ, Yuvasheva E, Pergolizzi JV. QTc interval prolongation byd-propoxyphene: what about other analgesics? Expert Opin Pharmacother 2012; 13:1397-409. [DOI: 10.1517/14656566.2012.682150] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Adler A, Viskin S, Bhuiyan ZA, Eisenberg E, Rosso R. Propoxyphene-induced torsades de pointes. Heart Rhythm 2011; 8:1952-4. [DOI: 10.1016/j.hrthm.2011.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 07/11/2011] [Indexed: 11/27/2022]
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Hanci V, Aydin M, Yurtlu BS, Ayoğlu H, Okyay RD, Taş E, Erdoğan G, Aydoğan K, Turan IO. Anesthesia induction with sevoflurane and propofol: evaluation of P-wave dispersion, QT and corrected QT intervals. Kaohsiung J Med Sci 2011; 26:470-7. [PMID: 20837343 DOI: 10.1016/s1607-551x(10)70074-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 03/25/2010] [Indexed: 12/24/2022] Open
Abstract
The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.
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Affiliation(s)
- Volkan Hanci
- Department of Anesthesiology and Reanimation, School of Medicine, Zonguldak Karaelmas University, Turkey.
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Abstract
PURPOSE Opioids may affect changes in the corrected QT interval (QTc) during anesthetic induction. This study examine whether a single bolus of remifentanil would prolong QTc after laryngeal mask airway (LMA) insertion during sevoflurane induction. MATERIALS AND METHODS Forty women of American Society of Anesthesiologists physical status 1 (ASA PS1) undergoing gynecological surgery were studied. All patients were induced using three vital capacity inhalation inductions with 5% sevoflurane. Two minutes after induction, the inspiratory concentration of sevoflurane was reduced to 2%. Using double-blinded randomization, patients were allocated into one of two groups, receiving either saline (placebo group, n = 20) or 0.25 μg.kg⁻¹ remifentanil (remifentanil group, n = 20) over a period of thirty seconds. Sixty seconds later, LMA insertion was performed. Recordings were taken with a 12-lead electrocardiogram at baseline, 2 min after induction and 1 and 3 min after LMA insertion. QTc was calculated by Bazett's formula. The mean arterial pressure (MAP) and heart rate (HR) were also measured at each time point. RESULTS The QTc interval was significantly prolonged in the placebo group as compared to the remifentanil group at 1 min after LMA insertion (467.8 ± 16.5 vs. 442.7 ± 21.3 ms, p < 0.001). However, there was no significant difference in QTc at 3 min after LMA insertion between the two groups. MAP and HR were significantly higher in the placebo group (p < 0.001). CONCLUSION A single bolus of remifentanil is safe method to attenuate prolonged QTc associated with insertion of LMA.
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Affiliation(s)
- Eun Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Hae Wone Chang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Korea
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García Ruiz N, Farré Pinilla M, Enríquez Bargalló S, Sistac Ballarín JM. [General anesthesia in a man with congenital long QT syndrome]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:187-188. [PMID: 21534297 DOI: 10.1016/s0034-9356(11)70031-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Higashijima U, Terao Y, Ichinomiya T, Miura K, Fukusaki M, Sumikawa K. A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction*. Anaesthesia 2010; 65:679-83. [PMID: 20528837 DOI: 10.1111/j.1365-2044.2010.06341.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SUMMARY The aim of this study was to determine the effect of thiamylal and propofol on heart rate-corrected QT (QTc) interval during anaesthetic induction. We studied 50 patients undergoing lumbar spine surgery. Patients were administered 3 microgxkg(-1) fentanyl and were randomly allocated to receive 5 mgxkg(-1) thiamylal or 1.5 mgxkg(-1) propofol as an induction agent. Tracheal intubation was performed after vecuronium administration. Heart rate, mean arterial pressure, bispectral index score, and 12-lead electrocardiogram were recorded at the following time points: just before (T1) and 2 min after (T2) fentanyl administration; 2 min after anaesthetic administration (T3); 2.5 min after vecuronium injection (T4); and 2 min after intubation (T5). Thiamylal prolonged (p < 0.0001), but propofol shortened (p < 0.0001), the QTc interval.
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Affiliation(s)
- U Higashijima
- Staff, Department of Anaesthesia, Nagasaki Rosai Hospital, Sasebo, Japan
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Kim S, Park S, Chae W, Jin H, Lee J, Kim Y. Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation. Br J Anaesth 2010; 104:150-7. [DOI: 10.1093/bja/aep355] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kaneko M, Yamaguchi S, Hamaguchi S, Egawa H, Fujii K, Ishikawa K, Kitajima T, Minami J. Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement. J Clin Anesth 2009; 21:555-61. [DOI: 10.1016/j.jclinane.2008.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 12/26/2008] [Accepted: 12/30/2008] [Indexed: 10/20/2022]
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Crawford EJT, Cochran D. Recurrent torsades de pointes in association with a very low calorie diet. Anaesthesia 2009; 64:903-7. [PMID: 19604196 DOI: 10.1111/j.1365-2044.2009.05940.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of very low calorie diets under medical supervision is becoming increasingly popular in the UK, as the incidence of obesity continues to rise. We report the case of torsades de pointes developing during such a diet. Torsades de pointes has been reported in association with very low calorie diets in the past but to our knowledge, this is the first report since the introduction of newer, nutritionally complete versions of the diet. We review the intensive care management of recurrent torsades de pointes resistant to standard therapy and its relationship to dieting and obesity.
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Affiliation(s)
- E-J T Crawford
- Department of Anaesthesia, Royal Bolton Hospital, Bolton, UK.
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Owczuk R, Twardowski P, Dylczyk-Sommer A, Wujtewicz MA, Sawicka W, Drogoszewska B, Wujtewicz M. Influence of promethazine on cardiac repolarisation: a double-blind, midazolam-controlled study. Anaesthesia 2009; 64:609-14. [DOI: 10.1111/j.1365-2044.2009.05890.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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