Prolongation of QT Interval in Association with the Administration of Large Doses of Opiates

Blair, John R.; Pruett, Jack K.; Crumrine, Robert S.; Balser, Jeffrey S.

doi:10.1097/00000542-198709000-00033

Cited by 42 publications

(9 citation statements)

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“…Fentanyl decreased the QTc interval in patients with long QT syndrome, but in other studies the QTc increased significantly following injection of fentanyl or sufentanil in patients with coronary artery disease [18][19][20]. The QTc interval at 90 s after injection of remifentanil 0.5 lg.kg )1 and 1.0 lg.kg )1 did not change compared with that before injection.…”

Section: Discussionmentioning

confidence: 86%

The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia

et al. 2008

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Summary Stimulation of the sympathetic nervous system associated with tracheal intubation causes corrected QT (QTc) interval prolongation. We postulated that the use of remifentanil during induction of anaesthesia might prevent this. Sixty unpremedicated, ASA grade 1 patients were selected and randomly allocated to receive either saline (group S), remifentanil 0.5 μg.kg−1 (group R 0.5) or remifentanil 1.0 μg.kg−1 (group R1.0) 1 min before laryngoscopy. The QTc interval was significantly prolonged immediately following intubation in group S and group R0.5, but it remained stable in group R1.0, compared with the QTc interval just before laryngoscopy. It is concluded that the administration of remifentanil 1.0 μg.kg−1 before intubation can prevent the prolongation of the QTc interval associated with tracheal intubation during induction of anaesthesia with sevoflurane.

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Section: Discussionmentioning

confidence: 86%

The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia

et al. 2008

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“…However, Korpinen et al [10] reported that b-blockers did not attenuate the QTc prolongation during induction of anaesthesia. The effect of opioids on the prolongation of the QTc interval during induction is unclear [13,19,20]. A dose of alfentanil 30 lg.kg )1 did not prevent the prolongation of the QTc interval following intubation [10], whereas alfentanil 25 lg.kg…”

Section: Discussionmentioning

confidence: 99%

Effects of fentanyl pretreatment on the QTc interval during propofol induction

Chang¹,

Kweon

Nam

et al. 2008

Anaesthesia

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SummaryProlongation of the corrected QT (QTc) interval is associated with various anaesthetic drugs. The QTc prolongation may become more exacerbated during laryngoscopy and intubation, which is possibly caused by sympathetic stimulation. The aim of this study was to investigate the effects of fentanyl on the QTc interval during propofol induction in healthy patients. The patients were randomly allocated to receive either fentanyl (n = 25) or saline (n = 25) before induction. The QTc interval was significantly prolonged immediately after intubation in control group compared to preceding values, but it did not change in the fentanyl group. The number of patients with the prolonged QTc interval exceeding 20 ms immediately after intubation compared to the baseline values was 14 in the control group and seven in the fentanyl group. In conclusion, pretreatment with fentanyl 2 μg.kg−1 significantly attenuated QTc prolongation associated with laryngoscopy and tracheal intubation during propofol induction.

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“…One report showed that pretreating patients with alfentanil has an attenuating effect on QT interval prolongation associated with laryngoscopy, but this effect was not observed in post-intubation QTc prolongation [90,91]. No studies have been reported in humans to evaluate the effects of sufentanil on QT interval, but a case report showed QT interval prolongation after 24 μg/kg sufentanil, in a patient undergoing cardiac surgery [92]. However, an experimental study on guinea pig hearts showed that sufentanil has no effect on repolarization and another on canine purkinje fibres demonstrated significant lengthening of QT duration caused by high concentrations of sufentanil concentration [93,94].…”

Section: Fentanylmentioning

confidence: 99%

Opioids and Cardiac Arrhythmia: A Literature Review

2018

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Objective: One of the most important side effects of opioids is their influence on the electrical activity of the heart. This review focusses on the effects of opioids on QT interval prolongation and their arrhythmogenic liability. Methods: By using various keywords, papers published up to 2018 in different databases were searched and identified. The search terms were opioids names, corrected QT interval, human-ether-a-go-go gene, torsades de pointes (TdP), cardiac arrhythmias, opioid dependence and other relevant terms. It emphasized the effects of each opioid agent alone on electrocardiogram (ECG) and some interactions. Results: Available data indicate that some opioids such as methadone are high-risk even at low doses, and have potential for prolongation of the QT interval and development of TdP, a dangerous ventricular tachycardia. A number of opioids such as tramadol and oxycodone are intermediate risk drugs and may develop long QT interval and TdP in high doses. Some other opioids such as morphine and buprenorphine are low-risk drugs and do not produce QT interval prolongation and TdP at least in routine doses. Opium-consumers are at higher risk of supra-ventricular arrhythmias, sinus bradycardia, cardiac block and atrial fibrillation. Conclusion: The cardiac arrhythmogenicity of various opioids is different. Methadone has a higher capability to induce long QT interval and dangerous arrhythmias in conventional doses than others. To reduce of arrhythmogenic risk, high doses of opioids must be used cautiously with periodic monitoring of ECG in high-risk consumers such as patients under opioid maintenance treatment.

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Prolongation of QT Interval in Association with the Administration of Large Doses of Opiates

Cited by 42 publications

References 0 publications

The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia

The effect of bolus administration of remifentanil on QTc interval during induction of sevoflurane anaesthesia

Effects of fentanyl pretreatment on the QTc interval during propofol induction

Opioids and Cardiac Arrhythmia: A Literature Review

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