Comparison of the effect of sevoflurane and desflurane on postoperative arrhythmia and QT dispersion

Gözdemir, Muhammet; Yeter, Ekrem; Akçay, Murat; Kurdoglu, Elvin; Gümüş, Tülin; Keleş, Telat; Bilen, Emine; Kanbak, Orhan

doi:10.2478/s11536-009-0115-5

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Desflurane was associated with persistent QTc prolongation (up to 30 min) in children, 54 and a high incidence (70%) of postoperative ventricular arrhythmias in adults. 68 A weak correlation between QTd increase and arrhythmia occurrence was found. 68 The effects of volatile agents on ECG torsadogenic markers are presented in Table 1.…”

Section: Desfluranementioning

confidence: 96%

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Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity

Staikou

Stamelos

Stavroulakis

2014

British Journal of Anaesthesia

103

119

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Drug-induced prolongation of cardiac repolarization may trigger malignant ventricular arrhythmias, such as torsade de pointes. The duration of QT interval, QT corrected for heart rate (QTc), JT interval, QT dispersion (QTd), QT variability index, and transmular dispersion of repolarization (TDR) are ECG markers of torsadogenicity. All volatiles, especially isoflurane and desflurane, have been found to prolong QTc and QTcd, while sevoflurane has probably no effects on TDR. Among i.v. anaesthetics, propofol seems superior due to its minimal effects on QTc and TDR; moreover, a decrease in QTc and QTcd has been demonstrated in many studies. Regarding opioids, fentanyl, alfentanil, and remifentanil produce no effects on QTc, while sufentanil, at high doses, may induce QT prolongation. Succinylcholine, but not the non-depolarizing neuromuscular blockers, produces QTc prolongation which can be attenuated by opioids and β-blockers. Reversal of neuromuscular block with anticholinesterase-anticholinergic combinations has been associated with significant QTc prolongation, while such an effect has not been demonstrated for sugammadex, even at high doses. Local anaesthetics have probably no intrinsic action on duration of repolarization; nevertheless, an extensive subarachnoid sympathetic block may increase the duration of QTc. On the contrary, thoracic epidural anaesthesia has been associated with a decrease in both QTc and TDR. Among adjuvants, midazolam seems to have no effect on QTc and TDR, while commonly used antiemetics, such as droperidol, domperidone, and most 5-HT3 antagonists, produce significant QT prolongation. The effects of anaesthetic drugs and techniques on electrocardiographic torsadogenic markers should be considered in the perioperative management of patients with preexisting repolarization abnormalities.

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Section: Desfluranementioning

confidence: 96%

“…68 A weak correlation between QTd increase and arrhythmia occurrence was found. 68 The effects of volatile agents on ECG torsadogenic markers are presented in Table 1. Data regarding halothane are not quite clear, while most studies indicate that isoflurane and desflurane prolong both QTc and QTd.…”

Section: Desfluranementioning

confidence: 96%

Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity

Staikou

Stamelos

Stavroulakis

2014

British Journal of Anaesthesia

103

119

View full text Add to dashboard Cite

show abstract

“…Even this issue is not entirely settled however, as some studies have shown that sevoflurane maintenance does not affect the QTc interval [30][31] . The literature is also inconsistent in regard to sevoflurane's effect on QTcd with some studies showing an increase [32][33][34] , and others showing a decrease 35 . In our study, in contrast to the increases in QTc interval, an overall neutral effect was observed for QTcd in both the groups compared to baseline.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Sevoflurane on the Transmural Dispersion of Repolarisation in Patients with Type 2 Diabetes Mellitus: A Prospective Observational Study

Thiruvenkatarajan

Jeyadoss

Kadam

et al. 2018

Anaesth Intensive Care

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The ‘torsadogenic’ property of a drug is linked to its ability to increase the transmural dispersion of repolarisation, represented by the interval between the peak of, and the end of, the T-wave (Tp-e interval) in an electrocardiogram. Reports have consistently shown that sevoflurane does not increase the Tp-e interval. Type 2 diabetes is a risk factor for increased QTc (rate-corrected QT interval), QTcd (rate-corrected QTc dispersion: difference between the maximum and the minimum QTc interval), and Tp-e, as well as the rate-corrected Tp-e (Tp-e/QTc ratio). The study aimed to ascertain whether sevoflurane increased the Tp-e interval and Tp-e/QTc ratio in patients with diabetes, thereby increasing their risk of torsades. We enrolled 35 female patients; 17 with type 2 diabetes and 18 controls undergoing non-laparoscopic surgery under sevoflurane anaesthesia. The Tp-e interval, Tp-e/QTc ratio, QTc and QTcd were recorded after intubation, 5, 10, 30 and 60 minutes into the anaesthetic, and were compared between the groups. No significant increase in the Tp-e interval or Tp-e/QTc was observed between or within the groups (a 13 ms increase was considered significant). In the control group, the QTc was significantly increased from baseline immediately after intubation (449 versus 414 ms, P <0.001); at 5 minutes (434 versus 414 ms, P=0.01); at 10 minutes (444 versus 414 ms, P=0.002); at 30 minutes (439 versus 414 ms, P=0.001) and at 60 minutes (442 versus 414 ms; P <0.001) (a 20 ms increase was considered significant). No significant increase in QTc was observed in the diabetic group. There were no between or within group differences observed for QTcd. Our findings suggest that sevoflurane does not have a significant predictable pro-arrhythmic effect in type 2 diabetic patients in the absence of other factors affecting ventricular repolarisation.

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Effects of different concentrations of desflurane on the index of cardiac electrophysiological balance in gynecologic surgery patients

Gao

et al. 2020

Can. J. Physiol. Pharmacol.

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The objectives were to observe the effects of different concentrations of desflurane on QT, QTc, Tp-e, Tp-e/QT, and the index of cardiac electrophysiological balance (iCEB). Sixty patients were randomly divided into group D1, group D2, and group D3 by using a random number table, 20 in each group. After entering the operating room, patients received 10 mL/kg hydroxyethyl starch, 0.1 mg/kg midazolam, 0.1 mg/kg vecuronium, 3 μg/kg fentanyl, and 0.3 mg/kg etomidate intravenously and then accepted intubation and mechanical ventilation. The desflurane evaporator was opened. The concentrations of desflurane in the D1, D2, and D3 groups were maintained at 0.6, 1.3, and 2.0 minimum alveolar concentration (MAC), respectively. Twelve-lead ECGs were recorded at time before induction (T1) and at 20 min after desflurane reached the required concentration (T2). HR and MAP were recorded measure and the QT interval, QTc interval, Tp-e interval, Tp-e/QT ratio, and iCEB were calculated. Compared with before inhalation (T1), the QTc interval was prolonged in the D1, D2, and D3 groups after inhalation of different concentrations of desflurane for 20 min (T2) (P < 0.05) and the Tp-e/QT ratio decreased in the D1 and D2 groups at T2 (P < 0.05). Compared with the D1 and D2 groups, the Tp-e/QT ratio of the D3 group increased at T2 (P < 0.05). There was no significant difference in Tp-e interval and iCEB at any time (P > 0.05). The study suggested that inhalation of desflurane at a normal concentration cannot cause arrhythmogenic characteristics and affect the cardiac electrophysiological stability.

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Comparison of the effect of sevoflurane and desflurane on postoperative arrhythmia and QT dispersion

Cited by 3 publications

References 22 publications

Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity

Impact of anaesthetic drugs and adjuvants on ECG markers of torsadogenicity

The Effect of Sevoflurane on the Transmural Dispersion of Repolarisation in Patients with Type 2 Diabetes Mellitus: A Prospective Observational Study

Effects of different concentrations of desflurane on the index of cardiac electrophysiological balance in gynecologic surgery patients

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