Differential effects of propofol and sevoflurane on QT interval during anesthetic induction

  • Makito Oji
  • Yoshiaki TeraoEmail author
  • Tomomi Toyoda
  • Tomoyuki Kuriyama
  • Kosuke Miura
  • Makoto Fukusaki
  • Koji Sumikawa
Original Research


There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.


Propofol Sevoflurane QT interval QT dispersion Dysrhythmias 



This research was supported, in part, by research funds of the Japan Labor Health and Welfare Organization to promote function.


  1. 1.
    Kleinsasser A, Kuenszberg E, Loeckinger A, Keller C, Hoermann C, Lindner KH, Puehringer F. Sevoflurane, but not propofol, significantly prolongs the QT interval. Anesth Analg. 2000;90:25–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Lindgren L, Yli-Hankala A, Randell T, Kirvela M, Scheinin M, Neuvonen PJ. Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation: comparison between propofol and thiopentone. Br J Anaesth. 1993;70:306–10.PubMedCrossRefGoogle Scholar
  3. 3.
    Higashijima U, Terao Y, Ichinomiya T, Miura K, Fukusaki M, Sumikawa K. A comparison of the effect on QT interval between thiamylal and propofol during anaesthetic induction. Anaesthesia. 2010;65:679–83.PubMedCrossRefGoogle Scholar
  4. 4.
    Saarnivaara L, Klemora UM, Lindgren L, Rautiainen P, Suvanto A. QT interval of the ECG, heart rate and arterial pressure using propofol, methohexital or midazolam for induction of anaesthesia. Acta Anaesthesiol Scand. 1990;34:276–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Kim DH, Kweon TD, Nam SB, Han DW, Cho WY, Lee JS. Effects of target concentration infusion of propofol and tracheal intubation on QTc interval. Anaesthesia. 2008;63:1061–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Kleinsasser A, Loeckinger A, Lindner KH, Keller C, Boehler M, Puehringer F. Reversing sevoflurane-associated Q-Tc prolongation by changing to propofol. Anaesthesia. 2001;56:248–50.PubMedCrossRefGoogle Scholar
  7. 7.
    Masui K, Upton RN, Doufas AG, Coetzee JF, Kazama T, Mortier EP, Struys MMRF. The performance of compartmental and physiologically based recirculatory pharmacokinetic models for propofol: a comparison using bolus, continuous, and target-controlled infusion data. Anesth Analg. 2010;111:368–79.PubMedCrossRefGoogle Scholar
  8. 8.
    Higham PD, Campbell RWF. QT dispersion. Br Heart J. 1994;71:508–10.PubMedCrossRefGoogle Scholar
  9. 9.
    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 Anaesth. 2004;21:566–70.Google Scholar
  10. 10.
    Silay E, Kati I, Tekin M, Guler N, Huseyinoglu UA, Coskuner I, Yagmur C. Comparison of the effects of desflurane and sevoflurane on the QTc interval and QT dispersion. Acta Cardiol. 2005;60:459–64.PubMedCrossRefGoogle Scholar
  11. 11.
    Ichinomiya T, Terao Y, Miura K, Higashijima U, Tanise T, Fukusaki M, Sumikawa K. QTc interval and neurological outcomes in aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2010;13:347–54.PubMedCrossRefGoogle Scholar
  12. 12.
    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;104:255–60.PubMedCrossRefGoogle Scholar
  13. 13.
    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;91:336–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Cowan JC, Yusoff K, Moore M, Amos PA, Gold AE, Bourke JP, Tansuphaswadikul S, Campbell RWF. Importance of lead selection in QT interval measurement. Am J Cardiol. 1988;61:83–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Chiladakis J, Kalogeropoulos A, Arvanitis P, Koutsogiannis N, Zagli F, Alexopoulos D. Heart rate-dependence of QTc intervals assessed by different correction methods in patients with normal or prolonged repolarization. PACE. 2010;33:553–60.PubMedCrossRefGoogle Scholar
  16. 16.
    Darpo B, Nebout T, Sager PT. Clinical evaluation of QT/QTc prolongation and proarrhythmic potential for nonantiarrhythmic drugs: the international conference on harmonization of technical requirements for registration of pharmaceuticals for human use E14 guideline. J Clin Pharmacol. 2006;46:498–507.PubMedCrossRefGoogle Scholar
  17. 17.
    Baum VC. Distinctive effects of three intravenous anesthetics on the inward rectifier (IK1) and delayed rectifier (IK) potassium currents in myocardium: implications for the mechanism of action. Anesth Analg. 1993;76:18–23.PubMedGoogle Scholar
  18. 18.
    Whyte SD, Booker PD, Buckley DG. The effects of propofol and sevoflurane on the QT interval and transmural dispersion of repolarization in children. Anesth Analg. 2005;100:71–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Hatakeyama N, Sakuraya F, Matsuda N, Kimura J, Kinoshita H, Kemmotsu O, Yamazaki M, Hattori Y. Pharmacological significance of the blocking action of the intravenous general anesthetic propofol on the slow component of cardiac delayed rectifier K+ current. J Pharmacol Sci. 2009;110:334–43.PubMedCrossRefGoogle Scholar
  20. 20.
    Wu MH, Su MJ, Sun SSM. Age-related propofol effects on electrophysiological properties of isolated hearts. Anesth Analg. 1997;84:964–71.PubMedGoogle Scholar
  21. 21.
    Michaloudis D, Fraidakis O, Kanoupakis E, Flossos A, Manios E. Idiopathic prolonged QT interval and QT dispersion: the effects of propofol during implantation of cardioverter-defibrillator. Eur J Anaesth. 1999;16:842–7.Google Scholar
  22. 22.
    Chang DL, Kweon TD, Nam SB, Lee JS, Shin CS, Park CH, Han DW. Effects of fentanyl pretreatment on QTc interval during propofol induction. Anaesthesia. 2008;63:1056–60.PubMedCrossRefGoogle Scholar
  23. 23.
    Pekdemir M, Karaca I, Cevic Y, Yanturali S, Ikay 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;73:813–7.PubMedGoogle Scholar
  24. 24.
    Mirvis DM. Spatial variation of the QT intervals in normal persons and patients with acute myocardial infarction. J Am Coll Cardiol. 1985;5:625–31.PubMedCrossRefGoogle Scholar
  25. 25.
    Ay B, Fak AS, Toprak A, Gogus YF, Oktay A. QT dispersion increases during intubation in patients with coronary artery disease. J Electrocardiol. 2003;36:99–104.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Makito Oji
    • 1
  • Yoshiaki Terao
    • 1
    Email author
  • Tomomi Toyoda
    • 1
  • Tomoyuki Kuriyama
    • 1
  • Kosuke Miura
    • 1
  • Makoto Fukusaki
    • 1
  • Koji Sumikawa
    • 2
  1. 1.Department of AnesthesiaNagasaki Rosai HospitalSaseboJapan
  2. 2.Department of AnesthesiologyNagasaki University School of MedicineNagasakiJapan

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