Influence of Spinal Anesthesia on Corrected QT Interval

Owczuk, Radosław; Sawicka, Wioletta; Wujtewicz, Magdalena A.; Kawecka, Aleksandra; Lasek, Jerzy; Wujtewicz, Maria

doi:10.1016/j.rapm.2005.06.005

Cited by 26 publications

(32 citation statements)

References 28 publications

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“…As QT interval changes along with heart rate -extending with bradycardia and shortening with tachycardia -independently of other factors, we found corrected QT interval according to heart rate interval (QTc). Even though a QTc interval of 440 milliseconds is considered prolonged, serious arrhythmias generally occur with a QTc interval of 600 milliseconds or longer 1,5,6,15,34 . Prolonged QRS duration and increased dispersion of repolarization had been demonstrated to increase the risk of arrhythmic cardiac death in coronary artery disease patients 1,5,35 .…”

Section: Discussionmentioning

confidence: 99%

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

Hancı¹,

Yurtlu²,

Karabağ³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: In our study we aimed to investigate the effect of esmolol, lidocaine and fentanyl on P-wave dispersion (Pwd), QT and corrected QT (QTc) durations and hemodynamic responses to endotracheal intubation during propofol induction. Methods: A total of eighty adult patients, American Society of Anesthesiologists (ASA) Physical Status I or II aged 18 to 60 years were included in this prospective, randomised, double-blind study. All patients had control electrocardiograms (ECGs) done before anesthesia induction. The patients were randomised into four equal groups. The control group (Group C) received saline 5 mL, the esmolol group (Group E) received esmolol 0.5 mg.kg -1 , the fentanyl group (Group F) received fentanyl 2 µg.kg -1 and the lidocaine group (Group L) received lidocaine 1.5 mg.kg -1 before

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Section: Discussionmentioning

confidence: 99%

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

Hancı¹,

Yurtlu²,

Karabağ³

et al. 2013

Rev. Bras. Anestesiol.

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Section: The Effect Of Regional Anaesthesia Techniques On the Period mentioning

confidence: 99%

“…What also remains important is the impact of baroreceptor stimulation and the effect of hypotension resulting from extensive sympathetic blockade. The adrenergic blockade as a result of spinal or epidural, not including T1-4 fibres, causes severe adrenergic activity above the level of the block and consequently prolongs repolarization [37,38].Left-sided stellate ganglion blockade may even lead to a shortening of the QT interval [39,40]. Left cardiac sympathetic denervation -LCSD's antifibrillatory effect -has been well described.…”

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confidence: 99%

The influence of regional anaesthesia and local anaesthetics on cardiac repolarization

Biernawska

Kaźmierczak

Kotfis

et al. 2016

Anaesthesiol Intensive Ther

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The normal function of the heart muscle is the result of electro-mechanic and hemodynamic coupling. Modification of the structure and activity of ion channels within the cardiomyocytes may induce cardiac arrhythmias. Electrophysiological mechanisms of arrhythmia, generated by a prolonged period of repolarization, result either from conduction disturbances (reentry mechanism) and/or the induction of beats (early after-depolarizations). Local anaesthetic drug deposition does not affect the repolarization period, as long as the concentration of the free drug in the plasma does not reach the critical value to cause toxic effects in the cardiomyocytes. When analyzing the effect of regional anaesthesia on the repolarization period it is essential to acknowledge the activity or blockade of adrenergic fibres. Blocking the sympathetic fibres' , including level T1 to T4, leads to a shortening of the QT interval and a reduction of QT dispersion. Adrenergic blockade as a result of spinal anaesthesia causes severe adrenergic activity above the level of the block and therefore prolongs repolarization. Stellate ganglion block on the right side causes a significant prolongation of the QT interval and QT dispersion. Regardless of the reasons for prolongation of the repolarization period (congenital or acquired), vigilance is required within the perioperative anaesthetic management of a patient, so as not to lead to the occurrence of ventricular arrhythmias. Regional anaesthesia techniques and properly used local anaesthetic drugs are regarded as being safe in these patients.Key words: long QT syndromes, cardiac repolarization, regional anaesthesia, local anaesthetics Anaesthesiology Intensive Therapy 2016, vol. 48, no 2, 135-141 CARDIAC ELECTROPHYSIOLOGYNormal function of the heart muscle is the result of electro-mechanic and haemodynamic coupling. When considering cardiac electrical activity from the point of view of a working myocardial cell, the following must be acknowledged: the relaxed state (polarization of the cell membrane) and active state (depolarization-repolarization) occurring after activation by the conduction system. Changes in the phases of action potential and the resting potential are the result of a synchronized movement of ionic currents through the ion channels, pumps and cardiomyocyte cell membrane carriers. The period of depolarization is initiated by an inward sodium current (I Na ), supported by an inward calcium current (I Ca-L ). During repolarization the flow of current occurs through the channels conducting the potassium current (I Kr , I Ks , I to , I K (ATP) ) and to a lesser extent by the sodium current (I Na ), calcium current (I Ca-L ) and non-selective cation channel (I NS ). This is depicted in Figure 1.The intracellular influx of calcium ions during the plateau phase enables a calcium dependent calcium release from the sarcoplasmic reticulum, leading to a contraction of the working myocardial cell. Under such physiological conditions during repolarization, potassium I Kr and I Ks...

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“…There are statistically significant changes in the QTc level at one, five and 15 min after induction of spinal anesthesia in normal healthy males and in some, the QTc was ≥ 440 msec. 44 This prolongation was thought to be secondary to hypotension as the heart rate did not change. 44 In a study comparing preeclamptic patients (not LQTS parturients) with healthy controls, the QTc was prolonged prior to induction of spinal anesthesia in the preeclamptic group (452 ± 17.5 msec) but not in the control group (376 ± 21.4 msec).…”

Section: Regional Anesthesiamentioning

confidence: 99%

“…44 This prolongation was thought to be secondary to hypotension as the heart rate did not change. 44 In a study comparing preeclamptic patients (not LQTS parturients) with healthy controls, the QTc was prolonged prior to induction of spinal anesthesia in the preeclamptic group (452 ± 17.5 msec) but not in the control group (376 ± 21.4 msec). 45 When the spinal was administered the QTc normalized in the preeclamptic group and remained stable in the control group.…”

Section: Regional Anesthesiamentioning

confidence: 99%

Brief review: Anesthetic implications of long QT syndrome in pregnancy

Drake

Preston

Douglas

2007

Can J Anesth/J Can Anesth

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Purpose:To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. Principal findings:The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.Conclusion: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.

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Influence of Spinal Anesthesia on Corrected QT Interval

Abstract: Spinal anesthesia provokes significant QTc interval prolongation in patients without cardiovascular disorders.

Cited by 26 publications

References 28 publications

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

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 influence of regional anaesthesia and local anaesthetics on cardiac repolarization

Brief review: Anesthetic implications of long QT syndrome in pregnancy

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