Effects of propofol on ventricular repolarization and incidence of malignant arrhythmias in adults

Post-operative Brugada electrocardiographic pattern, polymorphic ventricular tachycardia, and sudden death in a child after administration of propofol anaesthesia

“…12 Recent studies have found lower incidence of ventricular arrhythmias following administration of a single dose of propofol in an unselected cohort as well as adults with BrS. [13][14][15][16][17] Interestingly, a bolus dose of propofol has been shown to attenuate BrS-associated arrhythmogenic risk in high-risk adults with BrS patients in a recent study. 18 In contrast to adults in these studies [13][14][15][16][17][18] who did not have clinically significant symptoms following propofol administration (mean dose 2.2-3.3 mg/kg), those with propofol infusion syndrome were administered a higher dose of propofol (4.5-7.3 mg/kg/hour).…”

“…[13][14][15][16][17] Interestingly, a bolus dose of propofol has been shown to attenuate BrS-associated arrhythmogenic risk in high-risk adults with BrS patients in a recent study. 18 In contrast to adults in these studies [13][14][15][16][17][18] who did not have clinically significant symptoms following propofol administration (mean dose 2.2-3.3 mg/kg), those with propofol infusion syndrome were administered a higher dose of propofol (4.5-7.3 mg/kg/hour). 8 EKG changes in patients with BrS phenocopy due to propofol infusion syndrome have been shown to normalise as early as 24 hours after withdrawal of propofol, and provocative testing with sodium channel blockers typically does not reveal an underlying predisposition to BrS.…”

“…The dose of propofol (2 mg/kg) used in our patient is comparable to the dose utilised in adults who were administered a single propofol bolus (mean dose 2.2-3.3 mg/kg). 13,14,18 However, long-term use of antiarrhythmics such as amiodarone, β-blockers, calcium-channel blockers, and sodium channel blockers, which could have a bearing on the EKG changes and the risk of arrhythmogenesis during the procedure, was reported in one of the larger studies that found a low incidence of propofol infusion syndrome during and after short-term infusion of propofol. 13 Moreover, drug-induced BrS EKG changes can persist beyond the expected period of complete elimination of the offending drug from the body.…”

“…13,14,18 However, long-term use of antiarrhythmics such as amiodarone, β-blockers, calcium-channel blockers, and sodium channel blockers, which could have a bearing on the EKG changes and the risk of arrhythmogenesis during the procedure, was reported in one of the larger studies that found a low incidence of propofol infusion syndrome during and after short-term infusion of propofol. 13 Moreover, drug-induced BrS EKG changes can persist beyond the expected period of complete elimination of the offending drug from the body. 10 Taking into consideration all the available evidence, it is quite likely that our patient had drug-induced BrS rather than propofol infusionrelated BrS phenocopy.…”

Effects of anesthetic and sedative agents on sympathetic nerve activity

“…27 However, its use is associated with a low incidence of ventricular arrhythmias. 28 Propofol inhibits muscle SNA, HR, and BP and decreases baroreflex sensitivity. 29 When used to control the pressor response during surgery, the vasodilating effect of propofol overrides the neural vasoconstriction induced by surgery, and a further inhibition of the cardiac baroreflex is observed.…”