Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery Under General Anesthesia

Nägele, Peter; Pal, Swatilika; Brown, Frank; Blood, Jane; Miller, Joseph; Johnston, Joshua

doi:10.1097/01.sa.0000426602.85890.2b

Cited by 18 publications

(24 citation statements)

References 22 publications

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“…In addition to voriconazole, our patient had several other risk factors for QTc prolongation including transient hypomagnesemia, diabetes, female gender, receipt of perioperative anesthetics, and multiple arrhythmogenic medications, including azithromycin and ciprofloxacin . Both azithromycin and fluoroquinolones have been shown to increase QTc prolongation .…”

Section: Discussionmentioning

confidence: 92%

“…QTc prolongation is a common and potentially life‐threatening condition in patients who undergo solid organ or hematopoietic stem cell transplantation. The reasons for this are not entirely understood, but may include perioperative QTc‐prolonging medications and electrolyte imbalances . Other well‐described risk factors for post‐transplant QTc prolongation include structural heart disease, cardiac ischemia, thyroid disease, diabetes mellitus, female gender, and heritable cardiac syndromes …”

Section: Discussionmentioning

confidence: 99%

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Use of isavuconazole in a patient with voriconazole‐induced QTc prolongation

Trang

Hanretty

Langelier

et al. 2017

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Use of isavuconazole in a patient with voriconazole‐induced QTc prolongation

Trang

Hanretty

Langelier

et al. 2017

Transplant Infectious Dis

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“…Extrapulmonary side effects are mediated by the spillover of cytokines toward the systemic circulation, and may include liver injury, natural‐killer cell impairment and arrhytmias . The latter also include transient QT‐tract prolongation, which has been shown to occur in up to 80% of patients with possible evolution to torsade de pointe in 0.4% of these …”

Section: Injurious Effects Of General Anesthesia (Ga) and One‐lung Vementioning

confidence: 99%

From “awake” to “monitored anesthesia care” thoracic surgery: A 15 year evolution

Mineo

Tacconi

2014

Thoracic Cancer

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Although general anesthesia still represents the standard when performing thoracic surgery, the interest toward alternative methods is increasing. These have evolved from the employ of just local or regional analgesia techniques in completely alert patients (awake thoracic surgery), to more complex protocols entailing conscious sedation and spontaneous ventilation. The main rationale of these methods is to prevent serious complications related to general anesthesia and selective ventilation, such as tracheobronchial injury, acute lung injury, and cardiovascular events. Trends toward shorter hospitalization and reduced overall costs have also been indicated in preliminary reports. Monitored anesthesia care in thoracic surgery can be successfully employed to manage diverse oncologic conditions, such as malignant pleural effusion, peripheral lung nodules, and mediastinal tumors. Main non-oncologic indications include pneumothorax, emphysema, pleural infections, and interstitial lung disease. Furthermore, as the familiarity with this surgical practice has increased, major operations are now being performed this way. Despite the absence of randomized controlled trials, there is preliminary evidence that monitored anesthesia care protocols in thoracic surgery may be beneficial in high-risk patients, with noninferior efficacy when compared to standard operations under general anesthesia. Monitored anesthesia care in thoracic surgery should enter the armamentarium of modern thoracic surgeons, and adequate training should be scheduled in accredited residency programs.

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“…reported that QTc prolongation was common 30 minutes post‐operatively and likely due to medications given during surgery or surgical stress . This study was done on approximately 500 adult patients undergoing noncardiac surgery; one of these patients had an increase in QTc from 439 to 468 ms and developed TdP . As a result, in our denervation program, we try to avoid as much as possible agents that will stimulate sympathetic tone.…”

Section: Discussionmentioning

confidence: 99%

Effects on Repolarization Using Dynamic QT Interval Monitoring in Long‐QT Patients Following Left Cardiac Sympathetic Denervation

DeSimone

Bos

et al. 2015

Cardiovasc electrophysiol

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Background Videoscopic left cardiac sympathetic denervation (LCSD) is an adjunct therapy for reduction of arrhythmia-induced events in patients with long-QT syndrome (LQTS). LCSD reduces LQTS-triggered breakthrough cardiac events. The temporal effects of QTc changes post-LCSD have not been studied. Methods We utilized continuous QTc monitoring on 72 patients with LQTS. We evaluated acute and long-term QTc changes in comparison to 12-lead ECG-derived QTc values prior to surgery, 24 hours post-surgery, and at follow up ≥3 months. Results 72 patients underwent LCSD at our institution (46% male, mean age at LCSD was 14 ± 10 years). The mean baseline, pre-LCSD QTc was 505 ± 56 ms, which had decreased significantly at ≥3 months post-LCSD to 491 ± 40 ms (p = 0.001). QTc monitoring revealed that the majority of the cohort (53/72; 74%) had a transient increase >30 ms in QTc from baseline, with an average maximum increase of 72 ± 30 ms. Resolution within 10 ms of baseline or less occurred in 57% (30/53) at 24 hours post-LCSD. Conclusions Although LQTS patients may have a paradoxically increased QTc post-LCSD, the effects are transient in most patients. Importantly, no patients experienced any arrhythmias in the postoperative setting related to this transient rise in QTc.

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Postoperative QT Interval Prolongation in Patients Undergoing Noncardiac Surgery Under General Anesthesia

Cited by 18 publications

References 22 publications

Use of isavuconazole in a patient with voriconazole‐induced QTc prolongation

Use of isavuconazole in a patient with voriconazole‐induced QTc prolongation

From “awake” to “monitored anesthesia care” thoracic surgery: A 15 year evolution

Effects on Repolarization Using Dynamic QT Interval Monitoring in Long‐QT Patients Following Left Cardiac Sympathetic Denervation

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