Anesthetic Considerations for Pediatric Patients With Congenital Long QT Syndrome

Staudt, Genevieve E.; Watkins, Scott C.

doi:10.1053/j.jvca.2018.11.005

Cited by 10 publications

(25 citation statements)

References 52 publications

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“…Nevertheless, these patients are considered a group of high risk, since their risk for sudden cardiac death is increased more than twofold and is even higher among younger patients (Brygger and Herrstedt, 2014). According to Staudt and Watkins. (2019), the estimated incidence of hereditary QTc prolongation among newborns is 1 in 2,500 (Staudt and Watkins, 2019).…”

Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

“…According to Staudt and Watkins. (2019), the estimated incidence of hereditary QTc prolongation among newborns is 1 in 2,500 (Staudt and Watkins, 2019). Thus, despite the low chance of developing TdP or other lifethreatening arrhythmias, patients with a preexisting QTc prolongation need proper anesthesia planning to minimize the risk of adverse events.…”

Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

“…While measuring the QTc, one should keep in mind that there is a significant fluctuation of the interval during the day depending on the sympathetic activity and state of wakefulness (Brygger and Herrstedt, 2014). Values >480 msec on repeated testing or >460 msec in combination with a syncope will suggest LQTS (Staudt and Watkins, 2019). QTc >500 msec or an increase >60 msec is considered a significant risk factor for TdP and requires immediate intervention to avoid lethal arrhythmias (Brygger and Herrstedt, 2014).…”

Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

“…EKG monitoring and an action plan to promptly treat TdP and other arrhythmias, should they occur, is mandatory. (Charbit et al, 2005;Curigliano et al, 2009;Marbury et al, 2009;Owczuk et al, 2009;Drew et al, 2010;Brygger and Herrstedt, 2014;Chu et al, 2014;Perkins et al, 2015;Tracz and Owczuk, 2015;Täubel et al, 2017;Hellström and Al-Saffar, 2018;Lai and Huang, 2018;Hansen, 2019;Staudt and Watkins, 2019;Berul, 2020;Gan et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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PONV management in patients with QTc prolongation on the EKG

et al. 2021

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Postoperative nausea and vomiting (PONV) is a commonly encountered problem in surgical practice. It delays discharge from the post-anesthesia care unit, requires additional resources to treat, and may increase the morbidity in some patients. Many effective drugs are available to treat or prevent PONV, however many of these drugs have the potential to prolong the QTc on the electrocardiogram (EKG) and increase the risk of serious ventricular arrhythmias, in particular, torsade de pointes. The QTc prolongation may be a manifestation of a genetic mutation resulting in abnormal myocyte repolarization or it may be acquired and associated with the use of various medications, electrolyte disorders, and physiological conditions. Patients predisposed to QTc prolongation presenting for surgery constitute a challenging group, since many drugs commonly used for PONV management will put them at risk for perioperative serious arrhythmias. This is an important topic, and our mini-review is an attempt to highlight the problem, summarize the existing experience, and generate recommendations for safe management of PONV for patients, who are at increased risk of QTc prolongation and arrhythmias. Focused prospective studies will help to find definitive answers to the discussed problems and challenges and develop specific guidelines for clinical application.

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Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

Section: Prolonged Qtc and Anesthesiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

PONV management in patients with QTc prolongation on the EKG

et al. 2021

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“…Schwartz and Locati (1985) were the rst to publish studies on the natural history of the disease and noted a 71% mortality rate in patients who were left untreated after the rst syncope. That mortality rate has since been greatly reduced to 0.3% with appropriate medical treatment (4,5).…”

Section: Introductionmentioning

confidence: 99%

Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome

Yaman

Baydogan

İncesulu

et al. 2020

Preprint

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Background Long QT syndrome (LQTS) is an inherited disorder of the heart’s electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. The clinical symptoms of LQTS are heart palpitations, syncope, anoxic seizures secondary to ventricular arrhythmia, and torsades de pointes. Case: We present here a 17-month-old male patient with bilateral sensorineural hearing loss who underwent general anesthesia for a cochlear implant. The surgical team was advised about the possible risks of using local anesthesia without adrenaline. A defibrillator, which was checked for pediatric use, was made available in the operating room. After the vascular access was opened, the patient was provided with induction propofol, remifentanil, and rocuronium, and anesthesia was maintained using an intravenous anesthetic. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex. Discussion LQTS patients have developed arrhythmia and sudden cardiac arrest from administration of sevoflurane and neostigmine during anesthesia. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied. In addition, a defibrillator was available for immediate use during the perioperative period. Conclusion Anesthesia can be safe by using intravenous rocuronium and sugammadex and local anesthetic without adrenaline.

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Anesthesia for Long QT Syndrome

Babb

Mendoza

2021

Curr Anesthesiol Rep

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Anesthetic Considerations for Pediatric Patients With Congenital Long QT Syndrome

Cited by 10 publications

References 52 publications

PONV management in patients with QTc prolongation on the EKG

PONV management in patients with QTc prolongation on the EKG

Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome

Anesthesia for Long QT Syndrome

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