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Journal of Anesthesia

, Volume 30, Issue 6, pp 929–934 | Cite as

The effects of intravenous anesthetics on QT interval during anesthetic induction with sevoflurane

  • Yoshiaki TeraoEmail author
  • Ushio Higashijima
  • Tomomi Toyoda
  • Taiga Ichinomiya
  • Makoto Fukusaki
  • Tetsuya Hara
Original Article

Abstract

Purpose

Sevoflurane is known to prolong the QT interval. This study aimed to determine the effect of the interaction between intravenous anesthetics and sevoflurane on the QT interval.

Methods

The study included 48 patients who underwent lumbar spine surgery. Patients received 3 μg/kg fentanyl and were then randomly allocated to either Group T, in which they received 5 mg/kg thiamylal, or Group P, in which they received 1.5 mg/kg propofol, at 2 min after administration of fentanyl injection for anesthetic induction. Vecuronium (1.5 mg/kg) and sevoflurane (3 % inhaled concentration) were administered immediately after loss of consciousness and tracheal intubation was performed 3 min after vecuronium injection. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and the heart rate-corrected QT (QTc) interval on a 12-lead electrocardiogram were recorded immediately before fentanyl administration (T1), 2 min after fentanyl injection (T2), immediately before intubation (T3), and 2 min after intubation (T4).

Results

There were no significant differences between the two groups in baseline patient characteristics. BIS and MAP significantly decreased after anesthesia induction in both groups. At T3, MAP in Group T was higher than in Group P, while HR had reduced in both groups. The QTc interval was prolonged after anesthesia induction in Group T, but did not change at any time point in Group P. The QTc interval after anesthesia induction in Group T was longer than in Group P.

Conclusion

We concluded that an injection of propofol could counteract QTc interval prolongation associated with sevoflurane anesthesia induction.

Keywords

Propofol Sevoflurane Thiamylal QT interval QT dispersion Dysrhythmias 

Notes

Acknowledgments

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

References

  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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Oji M, Terao Y, Toyoda T, Kuriyama T, Miura K, Fukusaki M, Sumikawa K. Differential effects of propofol and sevoflurane on QT interval during anesthetic induction. J Clin Monit Comput. 2013;7:243–8.CrossRefGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    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;27:885–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Higham PD, Campbell RWF. QT dispersion. Br Heart J. 1994;71:508–10.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kaye AD, Volpi-Abadie J, Bensler JM, Kaye AM, Diaz JH. QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes. J Anesth. 2013;27:575–87.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.CrossRefPubMedGoogle 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.
    Shibata S, Ono K, Iijima T. Sevoflurane inhibition of the slowly activating delayed rectifier K+ current in guinea pig ventricular cells. J Pharmacol Sci. 2004;95:363–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Han DW, Park K, Jang SB, Kern SE. Modeling the effect of sevoflurane on corrected QT prolongation. A pharmacodynamics analysis. Anesthesiology. 2010;113:806–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Park WK, Pancrazio JJ, Suh CK, Lynch CIII. Myocardial depressant effects of sevoflurane. Mechanical and electrophysiologic action in vitro. Anesthesiology. 1996;84:1166–76.CrossRefPubMedGoogle Scholar
  21. 21.
    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. 2000;110:334–43.CrossRefGoogle Scholar
  22. 22.
    Wu MH, Su MJ, Sun SSM. Age-related propofol effects on electrophysiological properties of isolated hearts. Anesth Analg. 1997;84:964–71.CrossRefPubMedGoogle Scholar
  23. 23.
    Franks NP. Molecular targets underlying general anaesthesia. Br J Pharmacol. 2006;147:S72–81.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Kawano T, Oshita S, Takahashi A, Tsutsumi Y, Tomiyama Y, Kitahata H, Kuroda Y, Nakaya Y. Molecular mechanism of the inhibitory effects of propofol and thiamylal on sarcolemmal adenosine triphosphate-sensitive potassium channels. Anesthesiology. 2004;100:338–46.CrossRefPubMedGoogle Scholar
  25. 25.
    Kako H, Krishna SG, Sebastian R, Smih K, Tobias JD. Effect of dexmedetomidine on the QT interval in pediatric patients undergoing general anesthesia. J Anesth. 2015;29:8620–7.CrossRefGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar
  27. 27.
    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
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    Owczuk R, Wujtewicz MA, Zienciuk-Krajka A, Lasinska-Kowara M, Piankowski A, Wujtewicz M. The influence of anesthesia on cardiac repolarization. Minerva Anestesiol. 2012;78:483–95.PubMedGoogle Scholar
  31. 31.
    Yamaguchi M, Shimizu M, Ino H, Terai H, Uchiyama K, Oe K, Mabuchi T, Konno T, Taneda T, Mabuchi H. T wave peak-to-end interval and QT dispersion in acquired long QT syndrome: a new index for arrhythmogenicity. Clin Sci. 2003;105:671–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Staikou C, Stamelos M, Stavroulakis E. Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity. Br J Anaesth. 2014;112:217–30.CrossRefPubMedGoogle Scholar
  33. 33.
    Miyauchi Y, Katoh T, Iwasaki Y, Hayashi M, Mizuno K. Comparison and problems of manual and automated methods for detailed measurement of QT interval. Jpn J Electrocardiol. 2008;28:210–5.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2016

Authors and Affiliations

  1. 1.Department of AnesthesiaNagasaki Rosai HospitalSaseboJapan
  2. 2.Department of AnesthesiologyNagasaki University School of MedicineNagasakiJapan

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