Electrophysiological effects of desflurane in children with Wolff‐Parkinson‐White syndrome: a randomized crossover study

Hino, Hideki; Oda, Yutaka; Yoshida, Yoko; Suzuki, Tsugutoshi; Shimada, Mieko; Nishikawa, Kiyonobu

doi:10.1111/aas.13023

Cited by 10 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, propofol did not affect the refractory periods of normal and accessory pathways and did not interfere with EPS/ablation in a study with adult WPW patients [22]. Also, in children, propofol-based anaesthesia did not cause problems during EPS/RFCA [23,24]. Two randomised studies in youngsters undergoing RFCA, showed that propofol was similarly suitable with isoflurane, both leaving unaffected the SA and AV node function [25,26].…”

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

“…Also in children, when given after propofol, sevoflurane caused only moderate prolongation of the AP antegrade effective refractory period, without interfering with the ablative procedure [33]. On the other hand, desflurane at 1 MAC prolonged the AP effective refractory period and impaired the induction of diagnostic SVTs in paediatric patients [24]. The authors considered it unsuitable for EPS/ablative procedures [24].…”

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

“…On the other hand, desflurane at 1 MAC prolonged the AP effective refractory period and impaired the induction of diagnostic SVTs in paediatric patients [24]. The authors considered it unsuitable for EPS/ablative procedures [24].…”

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

“…Also, no adverse effects have been reported for nitrous oxide [34, 48-49, 54, 58]. Finally, desflurane has been found to prolong the refractory period of AP, without affecting the electrophysiology of sinoartrial node and normal pathways [24], but the available data are limited [59].…”

Section: Anaesthesia For Non-ablative Surgical Proceduresmentioning

confidence: 99%

See 3 more Smart Citations

erioperative management of patients with pre-excitation syndromes

2018

Rom J Anaesth Int Care

View full text Add to dashboard Cite

Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil , alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other preexcitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.

show abstract

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

Section: Anaesthesia For Electrophysiologic Investigation and Ablationmentioning

confidence: 99%

Section: Anaesthesia For Non-ablative Surgical Proceduresmentioning

confidence: 99%

See 2 more Smart Citations

erioperative management of patients with pre-excitation syndromes

2018

Rom J Anaesth Int Care

View full text Add to dashboard Cite

show abstract

“…Propofol is the most commonly used intravenous anaesthetic worldwide and has advantages over inhalation anaesthesia such as less postoperative nausea and emergence delirium especially in children, 1 widely used for anaesthesia to radiofrequency catheter ablation (RFCA) in paediatric patients, 2 and favoured over volatile anaesthetics 3 . Propofol is a safe intravenous anaesthetic, but can rarely cause severe atrioventricular (AV) blocks in humans 4‐9 .…”

Section: Introductionmentioning

confidence: 99%

Propofol suppresses the His‐ventricular conduction in paediatric patients

et al. 2020

View full text Add to dashboard Cite

What is known and objective Propofol is the most commonly used intravenous anaesthetic worldwide and is considered to be safe for all ages. However, there have been some reports that propofol induces severe atrioventricular (AV) blocks in humans and some studies demonstrated that propofol suppressed the cardiac conduction system in animals. A precise mechanism by which the block is induced has not been elucidated yet in humans. The objective of this study was to investigate the effects of propofol on the cardiac conduction system and the cardiac autonomic nervous balance in children. Methods We enrolled 23 paediatric patients (age: 6‐15 years; males: 16, females: 7) who were scheduled to undergo radiofrequency catheter ablation (RFCA) under general anaesthesia. Anaesthesia was induced with 2 mg/kg propofol and 0.5 µg/kg/min remifentanil, and tracheal intubation was performed with the aid of 1 mg/kg rocuronium. Anaesthesia was maintained with 5‐7 mg/kg/h propofol and 0.2 µg/kg/min remifentanil during the RFCA. After the completion of the RFCA, anaesthesia was further maintained with 5 mg/kg/h propofol and 0.2 µg/kg/min remifentanil for at least 10 min (LC: low propofol concentration state), followed by the injection of 2 mg/kg propofol and the infusion of 10 mg/kg/h propofol for 10 min (HC: high propofol concentration state). The sinus node recovery time (SNRT), sinoatrial conduction time (SACT), atrial‐His (AH) interval and the His‐ventricular (HV) interval were measured at the end of both the LC and HC. Cardiac autonomic regulation was simultaneously assessed based on heart rate variability. Results and discussion Propofol significantly suppressed intrinsic cardiac HV conduction, but did not affect the SNRT, SACT or the AH interval. As HV blocks, which occur below the His bundle, are often life‐threatening, the HV conduction delay may be a cause of severe AV blocks induced by propofol. Propofol directly suppressed parasympathetic nerve activity, and sympathetic nerve activity was also suppressed. What is new and conclusion These results indicate that propofol suppresses the HV conduction and might help to elucidate the mechanism by which propofol causes lethal AV blocks.

show abstract