The Safety of Modern Anesthesia for Children with Long QT Syndrome

Whyte, Simon; Nathan, Aruna T.; Myers, Dorothy; Watkins, Scott C.; Kannankeril, Prince J.; Etheridge, Susan P.; Andrade, Jason G.; Collins, Kathryn K.; Law, Ian H.; Hayes, Jason; Sanatani, Shubhayan

doi:10.1213/ane.0000000000000389

Cited by 24 publications

(17 citation statements)

References 24 publications

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“…Instead, central hospital databases or chart review are currently relied upon to examine drug utilization in the hospital setting. [18][19][20] Similarly, although Ontario pharmacy data include drugs dispensed to patients residing in long-term care facilities, pharmacy data in most other provinces do not capture drugs dispensed in this setting. 21 The comprehensiveness of data for drugs dispensed in the community also differs between provinces.…”

Section: Prescribing and Dispensing Patternsmentioning

confidence: 99%

An Introduction to Health Care Administrative Data

Cadarette

Wong

2015

CJHP

119

124

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Section: Prescribing and Dispensing Patternsmentioning

confidence: 99%

An Introduction to Health Care Administrative Data

Cadarette

Wong

2015

CJHP

119

124

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“…Hypokalemia and hypocalcemia are independent risk factors associated with a prolonged QT interval. Although electrolytes should be monitored closely, it is reasonable to consider treatment with 30 mg/kg magnesium given its low risk of toxicity and stabilizing effect on the myocardium (7). There was no electrolyte imbalance in this case, but magnesium was prepared for possible ventricular tachyarrhythmia (torsades de pointes [TdP]).…”

Section: Discussionmentioning

confidence: 99%

“…In a study of 158 anesthetics used on patients with LQTS, volatile agents were used to some degree in 81% of cases and their use was not related to the development of TdP. In practice, many published accounts of anesthesia used on children with LQTS, including the largest published case series comprising 103 children, demonstrated that sevo urane anesthesia can be safely administered to these patients without adverse effects (7). It has been suggested that continuation of beta-blocker therapy during the perioperative period may protect against TdP development that is related to an induced prolonged QT interval; however, there are case reports developing torsades de point, patients with LQTS may be more susceptible than different genotypes to arrhythmias induced by volatile agents; therefore, volatile agents should either be avoided altogether or used with great caution in these patients (8).…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome

Yaman

Baydogan

İncesulu

et al. 2020

Preprint

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Background Long QT syndrome (LQTS) is an inherited disorder of the heart’s electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. The clinical symptoms of LQTS are heart palpitations, syncope, anoxic seizures secondary to ventricular arrhythmia, and torsades de pointes. Case: We present here a 17-month-old male patient with bilateral sensorineural hearing loss who underwent general anesthesia for a cochlear implant. The surgical team was advised about the possible risks of using local anesthesia without adrenaline. A defibrillator, which was checked for pediatric use, was made available in the operating room. After the vascular access was opened, the patient was provided with induction propofol, remifentanil, and rocuronium, and anesthesia was maintained using an intravenous anesthetic. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex. Discussion LQTS patients have developed arrhythmia and sudden cardiac arrest from administration of sevoflurane and neostigmine during anesthesia. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied. In addition, a defibrillator was available for immediate use during the perioperative period. Conclusion Anesthesia can be safe by using intravenous rocuronium and sugammadex and local anesthetic without adrenaline.

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“…Among the medication listed in Table 1, sevoflurane and ondansetron are remarkable (given its widespread use in pediatric anesthesia) because both drugs prolong QT interval but not Tp-Te interval, not increasing the risk of torsade de pointes in healthy children [9][10][11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Atropine-Induced Bigeminy by Treating Bradycardia-Dependent Ectopy

Rebollar¹,

Palacios²,

Guerrero³

et al. 2016

Cardiovasc Pharm Open Access

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We report the case of a 9-year-old healthy boy who underwent day-surgery herniotomy under combined general and regional anesthesia. After inhalational induction, borderline bradycardia with Premature Ventricular Contractions (PVCs) was observed in ECG tracing, which worsened despite the adequate anesthetic management to avoid and treat arrhythmogenic triggers. Subsequent diagnostic tests were performed to rule out an underlying heart disease. Thereby, we conduct a brief review of ventricular ectopy in children with structurally normal hearts, both in the clinical and perioperative setting; and finally linked to our case in order to find out the cause of the abnormal electrical activity.

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The Safety of Modern Anesthesia for Children with Long QT Syndrome

Cited by 24 publications

References 24 publications

An Introduction to Health Care Administrative Data

An Introduction to Health Care Administrative Data

Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome

Atropine-Induced Bigeminy by Treating Bradycardia-Dependent Ectopy

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