Anesthesia Induction With Sevoflurane and Propofol: Evaluation of P‐wave Dispersion, QT and Corrected QT Intervals

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.

Efeitos de esmolol, lidocaína e fentanil nos intervalos dispersão da onda P, QT, QTc e respostas hemodinâmicas à intubação endotraqueal durante indução com propofol: um estudo comparativo

“…Exclusion criteria were: pregnancy, anorexia (BMI < 18 kg.m -2 ), obesity (BMI > 30 kg.m -2 ), chronic liver and kidney diseases, electrolyte disorders, diabetes mellitus, hypothyroidism or hyperthyroidism, alcohol addiction, coronary artery disease, Chagas disease, cardiomyopathy, arterial hypertension, atrial and/or ventricular hypertrophy on ECG, arrhythmia, cardiomegaly, valvular disease, cardiac insuffi ciency, and use of medication that led to extended QT intervals 1,5,6,15 .…”

“…Previous studies demonstrated that Pwd and QTc intervals might be extended in conditions such as diabetes mellitus 9,10 , hypertension 11,12 , malnutrition 5 , subarachnoid hemorrhage 6 , obesity 13,14 and metabolic syndrome 15 . Also Pwd and QTc intervals extended after laryngoscopy and tracheal intubation 1,2 . For this reason, in patients with prolonged Pwd and QTc interval, choice of anesthetic and adjuvant drugs is important.…”

“…Anesthetic agents may display proarrhythmic and antiarrhythmic activity by inducing electrical activity through various mechanisms 1 . Other than the anesthetic agents used, existing heart disease and other concomitant systemic diseases, laryngoscopy and tracheal intubation, surgical manipulation, procedures performed on the patient, and medication may also cause arrhythmia in the intraoperative period 2 .…”

“…Other than the anesthetic agents used, existing heart disease and other concomitant systemic diseases, laryngoscopy and tracheal intubation, surgical manipulation, procedures performed on the patient, and medication may also cause arrhythmia in the intraoperative period 2 . These effects can be determined on 12-lead electrocardiograms (ECGs) by measuring P-wave dispersion (Pwd) and QT and corrected QT (QTc) intervals [1][2][3][4][5][6] . Pwd is defi ned as the difference between the maximum and minimum P-wave duration in 12 leads of surface ECGs.…”

“…Pwd is defi ned as the difference between the maximum and minimum P-wave duration in 12 leads of surface ECGs. Pwd is simple and non-invasive indicator of atrial arrhythmia such as atrial fl utter or atrial fi brillation 1,[3][4][5][6] . Increased Pwd is accepted as a predictor of postoperative atrial fi brillation after coronary artery surgery 7,8 .…”