Duration of the Surgery and Age are Risk Factors for QTc Interval Prolongation under General Anaesthesia with Volatile Anesthetics

Waxler, Beverly; Margeta, Bosko; Tureanu, Luminita; Fogg, Louis

doi:10.4172/2155-6148.1000254

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…We intend to find other anaesthetic agents that could attenuate these QTc interval prolongation because as per the Food and Drug Administration guidelines, QTc interval remains a standard marker to assess the arrhythmic potential of a new drug 29 . Fourth, many of our patients had hypertension or diabetes mellitus, which can influence QTc interval under general anaesthesia 30 . However, the proportions of hypertension or diabetes mellitus were similar among the three groups, and may not have interfered with our findings.…”

Section: Discussionmentioning

confidence: 71%

Effect of different general anaesthetics on ventricular repolarisation in robot‐assisted laparoscopic prostatectomy

Park

Lee

Choi

et al. 2020

Acta Anaesthesiol Scand

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Background Ventricular repolarisation is affected differently by the types of anaesthetics used. This study aimed to compare the effect of different types of anaesthetics on ventricular repolarisation during robot‐assisted laparoscopic radical prostatectomy (RALP). Methods Sixty‐nine patients were randomly assigned in a 1:1:1 ratio to the Sevoflurane (sevoflurane/remifentanil), Desflurane (desflurane/remifentanil) or total intravenous anaesthesia (TIVA [propofol/remifentanil]) groups; however, only 67 patients completed the study. The primary outcome was heart rate‐corrected QT (QTc) interval collected at nine time points during RALP. Bazett’s (QTcB) and Fridericia’s (QTcF) formulae were used for QT interval correction. The secondary outcomes were Tpeak‐Tend (Tp‐e) interval and Tp‐e/QT ratio that were collected at the same time points. Results The QTcB and QTcF intervals were significantly prolonged during surgery in all groups; however, these values showed significant intergroup differences with time. After assuming the Trendelenburg position, the QTcB and QTcF intervals were significantly longer in the Desflurane group than in the other two groups, and this prolongation continued until the end of surgery. Intra‐operatively, the QTcB and QTcF intervals exceeded 450 ms in six and five patients, respectively, in the Desflurane group, but in none in the TIVA group. Moreover, the incidence of intra‐operative QTc interval prolongation >20 ms and >60 ms was significantly higher in the Desflurane group than in the TIVA group. There were no significant differences in Tp‐e intervals and Tp‐e/QT ratio among the three groups during surgery. Conclusions To minimise QTc interval prolongation during RALP, TIVA with propofol/remifentanil is recommended for general anaesthesia.

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Section: Discussionmentioning

confidence: 71%

Effect of different general anaesthetics on ventricular repolarisation in robot‐assisted laparoscopic prostatectomy

Park

Lee

Choi

et al. 2020

Acta Anaesthesiol Scand

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“…The same study revealed that 39% of patients exposed to sevoflurane had significant QTc prolongation (>30 ms). Data from another observational study revealed that the presence of diabetes may be a predominant risk factor for perioperative prolongation of QTc interval regardless of the anaesthetic technique 41 . It has to be noted however, that both these studies failed to analyse the torsadogenic parameters such as Tp-e and Tp-e/QTc ratio 40,41 .…”

Section: Discussionmentioning

confidence: 98%

The Effect of Sevoflurane on the Transmural Dispersion of Repolarisation in Patients with Type 2 Diabetes Mellitus: A Prospective Observational Study

Thiruvenkatarajan

Jeyadoss

Kadam

et al. 2018

Anaesth Intensive Care

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The ‘torsadogenic’ property of a drug is linked to its ability to increase the transmural dispersion of repolarisation, represented by the interval between the peak of, and the end of, the T-wave (Tp-e interval) in an electrocardiogram. Reports have consistently shown that sevoflurane does not increase the Tp-e interval. Type 2 diabetes is a risk factor for increased QTc (rate-corrected QT interval), QTcd (rate-corrected QTc dispersion: difference between the maximum and the minimum QTc interval), and Tp-e, as well as the rate-corrected Tp-e (Tp-e/QTc ratio). The study aimed to ascertain whether sevoflurane increased the Tp-e interval and Tp-e/QTc ratio in patients with diabetes, thereby increasing their risk of torsades. We enrolled 35 female patients; 17 with type 2 diabetes and 18 controls undergoing non-laparoscopic surgery under sevoflurane anaesthesia. The Tp-e interval, Tp-e/QTc ratio, QTc and QTcd were recorded after intubation, 5, 10, 30 and 60 minutes into the anaesthetic, and were compared between the groups. No significant increase in the Tp-e interval or Tp-e/QTc was observed between or within the groups (a 13 ms increase was considered significant). In the control group, the QTc was significantly increased from baseline immediately after intubation (449 versus 414 ms, P <0.001); at 5 minutes (434 versus 414 ms, P=0.01); at 10 minutes (444 versus 414 ms, P=0.002); at 30 minutes (439 versus 414 ms, P=0.001) and at 60 minutes (442 versus 414 ms; P <0.001) (a 20 ms increase was considered significant). No significant increase in QTc was observed in the diabetic group. There were no between or within group differences observed for QTcd. Our findings suggest that sevoflurane does not have a significant predictable pro-arrhythmic effect in type 2 diabetic patients in the absence of other factors affecting ventricular repolarisation.

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The prevalence of long QT interval in post-operative intensive care unit patients

Pham

Banks

Narotsky

et al. 2015

J Clin Monit Comput

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The severity of patient illnesses and medication complexity in post-operative critically ill patients increase the risk for a prolonged QT interval. We determined the prevalence of prolonged QTc in surgical intensive care unit (SICU) patients. We performed a prospective cross-sectional study over a 15-month period at a major academic center. SICU pre-admission and admission EKGs, patient demographics, and laboratory values were analyzed. QTc was evaluated as both a continuous and dichotomous outcome (prolonged QTc > 440 ms). 281 patients were included in the study: 92 % (n = 257) post-operative and 8 % (n = 24) non-operative. On pre-admission EKGs, 32 % of the post-operative group and 42 % of the non-operative group had prolonged QTc (p = 0.25); on post-admission EKGs, 67 % of the post-operative group but only 33 % of the non-operative group had prolonged QTc (p < 0.01). The average change in QTc in the post-operative group was +30.7 ms, as compared to +2 ms in the non-operative group (p < 0.01). On multivariable adjustment for long QTc as a dichotomous outcome, pre-admission prolonged QTc (OR 3.93, CI 1.93-8.00) and having had an operative procedure (OR 4.04, CI 1.67-9.83) were associated with developing prolonged QTc. For QTc as a continuous outcome, intra-operative beta-blocker use was associated with a statistically-significant decrease in QTc duration. None of the patients developed a lethal arrhythmia in the ICU. Prolonged QTc is common among post-operative SICU patients (67 %), however lethal arrhythmias are uncommon. The operative experience increases the risk for long QTc.

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Duration of the Surgery and Age are Risk Factors for QTc Interval Prolongation under General Anaesthesia with Volatile Anesthetics

Cited by 3 publications

References 26 publications

Effect of different general anaesthetics on ventricular repolarisation in robot‐assisted laparoscopic prostatectomy

Effect of different general anaesthetics on ventricular repolarisation in robot‐assisted laparoscopic prostatectomy

The Effect of Sevoflurane on the Transmural Dispersion of Repolarisation in Patients with Type 2 Diabetes Mellitus: A Prospective Observational Study

The prevalence of long QT interval in post-operative intensive care unit patients

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