QT Interval Prolongation and Torsade de Pointes Induced by Propofol and Hypoalbuminemia

Abstract

SummaryWe report the case of a 70-year-old man presenting with the development of torsade de pointes (TDP) during infusion of propofol in the setting of severe hypoalbuminemia. TDP developed 15 hours after the beginning of a standard infusion of propofol, following the development of a prominent U wave and prolongation of the QTc interval. While the serum concentrations of electrolytes were within normal ranges, serum albumin as low as 1.4 mg/dL was observed. TDP disappeared during the infusion of isoproterenol, and QTc normalized after the discontinuation of propofol. We hypothesize that hypoalbuminemia increased the free fraction of propofol, causing marked QTc prolongation and TDP. (Int Heart J 2010; 51: 365-366) Key words: Torsade de pointes, Long QT syndrome A few cases of propofol-induced QT prolongation complicated by torsade de pointes (TDP) have been reported. 1-3) However, the mechanism implicated in these arrhythmic events is still unclear. We observed the development of TDP during the infusion of propofol in the presence of severe hypoalbuminemia, and discuss a putative link between TDP and low serum albumin. Case ReportA 70-year-old man was admitted to our hospital with a diagnosis of infective endocarditis. He had a history of paroxysmal atrial fibrillation and was permanently paced for sick sinus syndrome. On admission, his body height was 166 cm and weight 70 kg. Cefazoline, 8 g daily, was administered intravenously. The patient developed large, bilateral pleural effusions and, on the 14 th day after his admission to the hospital, he was intubated and artificially ventilated. A 95-mg bolus of propofol was given intravenously for the induction of sedation, followed by a 0.98-mg/kg/hour continuous infusion to allow continuous ventilation. Following the development of a prominent U wave and prolongation of the QTc interval to 712 ms ( Figure 1B ; after the administration of propofol, the QTc interval lengthened from 398 to 712 ms (B); after discontinuation of propofol, the QTc interval shortened to 461 ms (C).

The Effects of Local Anaesthetics on QT Parameters during Thoracic Epidural Anaesthesia Combined with General Anaesthesia: Ropivacaine versus Bupivacaine

“…Propofol-induced prolongation of the QTc interval has been observed in various studies (17)(18)(19). In the present study, the QT interval was prolonged after propofol injection, but we did not observe any QTc prolongation with propofol usage.…”

Risk factors for early postoperative arrhythmias in general surgery patients after general anesthesia

“…Results of previous studies were not consistent regarding the possibility that propofol prolonged the QT-interval [15]. There are some case reports and observational studies in which it was proposed that propofol may cause intra-operative arrhythmias in conjunction with other acquired or hereditary pro-arrhythmic factors [16,17,18]. However, in our study, propofol was used only for the induction of anaesthesia.…”

QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

“…Irie et al [17] described a QT interval prolongation andtorsadesdepointesinduced by propofol and hypoalbuminemia in a 70-year-old man presented with IE. …”