Effect of Anaesthetic Agents on P‐wave Dispersion on the Electrocardiogram: Comparison of Propofol and Desflurane

Abstract

Anaesthetics influence cardiac electrical activity by various mechanisms; thus, they may have pro-arrhythmic or anti-arrhythmic actions. Increased P-wave dispersion is associated with a risk of paroxysmal atrial fibrillation. The aim of the present study was to analyse the impact of propofol and desflurane on changes in P wave dispersion, which may reflect the anti-arrhythmic effects of these drugs. Fifty patients undergoing scheduled surgery were included in the study. Patients were divided into two equal groups: a propofol group and a desflurane group. Patients in the propofol group were initially administered 2.5 mg/kg propofol, followed by infusion of 6 mg/kg per h propofol. Anaesthesia in the desflurane group was achieved using inhalation induction, with concentrations up to 8-12.5 vol%. When signs of adequate anaesthesia were observed, the concentration of desflurane was reduced to 6 vol%. An electrocardiogram (ECG) was obtained before induction and then again 1, 3 and 5 min after the initiation of propofol infusion or the induction of anaesthesia in the desflurane group; additional measurements were performed after tracheal intubation. P-wave dispersion was assessed by differences in maximal and minimal P-wave duration on a 12-lead ECG. P-wave dispersion did not change over time in the desflurane group. In the propofol group, there was a significant decrease in P-wave dispersion after 3 and 5 min of anaesthesia. Significant differences were observed between study groups after 1, 3 and 5 min of anaesthesia, and disappeared after tracheal intubation. Mean and maximal P-wave duration did not change in either group. In conclusion, propofol decreases P-wave dispersion and this seems to be connected with the anti-arrhythmic properties of the drug.

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

“…The general anesthetic sevofl urane has been reported to prolong Pwd, while desfl urane has no effect on it, and propofol shortens it 1,48,49 . Pwd intervals also extend after laryngoscopy and tracheal intubation 1 .…”

“…Previously, it was demonstrated that inhalation anesthetic agents such as desfl urane, sevofl urane, isofl urane, enfl urane or halothane, extend the QTc interval duration 1,3,4,17 . Despite the fact that etomidate and midazolam have no effects on the ventricle repolarization 3,17 , they are not popular drugs for anesthesia induction. Propofol as an intravenous anesthetic agent is a popular choice for anesthesia induction in patients with prolonged QT, QTc, and Pwd interval, since it causes minimal prolongation of QT, QTc, and Pwd interval 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 . 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 .…”

Efeito de levobupivacaína e bupivacaína nas dispersões da onda P, QT e QT corrigido (QTc) em cesariana

“…The general anesthetic sevofl urane has been reported to prolong Pwd, desfl urane to have no effect on it, and propofol to shorten it [22][23][24] . At the same time, our literature survey found no study that investigated the effects of local or spinal anesthesia on Pwd.…”