The Effects of Intravenous Anesthetics on QT Interval During Anesthetic Induction with Desflurane

Overview

Journal JA Clin Rep

Date 2020 Feb 7

PMID 32025881

Authors

Shozo Tominaga

Yoshiaki Terao

Shigehiko Urabe

Maki Ono

Natsuko Oji

Makito Oji

Makoto Fukusaki

Tetsuya Hara

Affiliations

Soon will be listed here.

Abstract

Introduction: This study aimed to determine the effects of the interaction between intravenous anesthetics and desflurane on the QT interval.

Methods: Fifty patients who underwent lumbar spine surgery were included. The patients received 3 μg/kg fentanyl and were randomly divided into two groups: group P patients received 1.5 mg/kg propofol and group T patients received 5 mg/kg thiamylal 2 min after fentanyl injection. All patients received rocuronium and desflurane (6% inhaled concentration) after loss of consciousness. Tracheal intubation was performed 3 min after rocuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiograms were recorded before fentanyl injection (T1), 2 min after fentanyl injection (T2), 1 min after propofol or thiamylal injection (T3), immediately before intubation (T4), and 2 min after intubation (T5).

Results: There were no significant intergroup differences in patient characteristics. BIS and MAP decreased after anesthesia induction in both groups. MAP values at T3, T4, and T5 in group T were higher than those in group P. HR did not change over time or differ between the groups. The QTc intervals at T4 and T5 in group T were longer than those at T1. In group P, the QTc interval at T3 was significantly shorter than that at T1. The QTc intervals at T3, T4, and T5 in group T were significantly longer than those in group P.

Conclusions: A propofol injection could counteract the QTc interval prolongation during desflurane anesthesia induction.

Trial Registration: UMIN Clinical Trials Registry database reference number: UMIN000023707 . This study was registered on August 21, 2016.

References

Charbit B, Samain E, Merckx P, Funck-Brentano C . QT interval measurement: evaluation of automatic QTc measurement and new simple method to calculate and interpret corrected QT interval. Anesthesiology. 2006; 104(2):255-60. DOI: 10.1097/00000542-200602000-00009. View

Kim S, Park S, Chae W, Jin H, Lee J, Kim Y . Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation. Br J Anaesth. 2009; 104(2):150-7. DOI: 10.1093/bja/aep355. View

Liu Q, Kong A, Chen R, Qian C, Liu S, Sun B . Propofol and arrhythmias: two sides of the coin. Acta Pharmacol Sin. 2011; 32(6):817-23. PMC: 3505762. DOI: 10.1038/aps.2011.42. View

Kreuer S, Bruhn J, Larsen R, Hoepstein M, Wilhelm W . Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia. Br J Anaesth. 2003; 91(3):336-40. DOI: 10.1093/bja/aeg189. View

Franks N . Molecular targets underlying general anaesthesia. Br J Pharmacol. 2006; 147 Suppl 1:S72-81. PMC: 1760740. DOI: 10.1038/sj.bjp.0706441. View

Kang J, Reynolds W, Chen X, Ji J, Wang H, Rampe D . Mechanisms underlying the QT interval-prolonging effects of sevoflurane and its interactions with other QT-prolonging drugs. Anesthesiology. 2006; 104(5):1015-22. DOI: 10.1097/00000542-200605000-00018. View

Yildirim H, Adanir T, Atay A, Katircioglu K, Savaci S . The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesthesiol. 2004; 21(7):566-70. DOI: 10.1017/s0265021504007112. View

Kawano T, Oshita S, Takahashi A, Tsutsumi Y, Tomiyama Y, Kitahata H . Molecular mechanisms of the inhibitory effects of propofol and thiamylal on sarcolemmal adenosine triphosphate-sensitive potassium channels. Anesthesiology. 2004; 100(2):338-46. DOI: 10.1097/00000542-200402000-00024. View

Higham P, CAMPBELL R . QT dispersion. Br Heart J. 1994; 71(6):508-10. PMC: 1025441. DOI: 10.1136/hrt.71.6.508. View

10.

Oji M, Terao Y, Toyoda T, Kuriyama T, Miura K, Fukusaki M . Differential effects of propofol and sevoflurane on QT interval during anesthetic induction. J Clin Monit Comput. 2012; 27(3):243-8. DOI: 10.1007/s10877-012-9420-7. View

11.

Kaye A, Volpi-Abadie J, Bensler J, Kaye A, Diaz J . QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes. J Anesth. 2013; 27(4):575-87. DOI: 10.1007/s00540-013-1564-1. View

12.

Silay E, Kati I, Tekin M, Guler N, Huseyinoglu U, Coskuner I . Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion. Acta Cardiol. 2005; 60(5):459-64. DOI: 10.2143/AC.60.5.2004964. View

13.

Owczuk R, Wujtewicz M, Sawicka W, Piankowski A, Polak-Krzeminska A, Morzuch E . The effect of intravenous lidocaine on QT changes during tracheal intubation. Anaesthesia. 2008; 63(9):924-31. DOI: 10.1111/j.1365-2044.2008.05525.x. View

14.

Terao Y, Higashijima U, Toyoda T, Ichinomiya T, Fukusaki M, Hara T . The effects of intravenous anesthetics on QT interval during anesthetic induction with sevoflurane. J Anesth. 2016; 30(6):929-934. DOI: 10.1007/s00540-016-2252-8. View

15.

Chang D, Kweon T, Nam S, Lee J, Shin C, Park C . Effects of fentanyl pretreatment on the QTc interval during propofol induction. Anaesthesia. 2008; 63(10):1056-60. DOI: 10.1111/j.1365-2044.2008.05559.x. View

16.

Toyoda T, Terao Y, Oji M, Okada M, Fukusaki M, Sumikawa K . The interaction of antiemetic dose of droperidol with propofol on QT interval during anesthetic induction. J Anesth. 2013; 27(6):885-9. DOI: 10.1007/s00540-013-1625-5. View

17.

Owczuk R, Wujtewicz M, Sawicka W, Lasek J, Wujtewicz M . The Influence of desflurane on QTc interval. Anesth Analg. 2005; 101(2):419-422. DOI: 10.1213/01.ANE.0000154198.41162.FA. View

18.

Pekdemir M, Karaca I, Cevik Y, Yanturali S, Ilkay E . The diagnostic value of QT dispersion for acute coronary syndrome in patients presenting with chest pain and nondiagnostic initial electrocardiograms. Mt Sinai J Med. 2006; 73(5):813-7. View

19.

Mirvis D . Spatial variation of QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1985; 5(3):625-31. DOI: 10.1016/s0735-1097(85)80387-9. View

20.

Park W, Kim M, Ahn D, Chae J, Jee Y, Chung N . Myocardial depressant effects of desflurane: mechanical and electrophysiologic actions in vitro. Anesthesiology. 2007; 106(5):956-66. DOI: 10.1097/01.anes.0000265155.01815.6d. View