Propofol and arrhythmias: two sides of the coin

Abstract

The hypnotic agent propofol is effective for the induction and maintenance of anesthesia. However, recent studies have shown that propofol administration is related to arrhythmias. Propofol displays both pro- and anti-arrhythmic effects in a concentration-dependent manner. Data indicate that propofol can convert supraventricular tachycardia and ventricular tachycardia and may inhibit the conduction system of the heart. The mechanism of the cardiac effects remains poorly defined and may involve ion channels, the autonomic nervous system and cardiac gap junctions. Specifically, sodium, calcium and potassium currents in cardiac cells are suppressed by clinically relevant concentrations of propofol. Propofol shortens the action potential duration (APD) but lessens the ischemia-induced decrease in the APD. Furthermore, propofol suppresses both sympathetic and parasympathetic tone and preserves gap junctions during ischemia. All of these effects cumulatively contribute to the antiarrhythmic and proarrhythmic properties of propofol.

Does Anesthesia Induction during Electrophysiologic Studies Induce Tachycardia in Pediatric Patients

“…Much has been published about potential side effects of these anesthetic agents on cardiac and accessory pathway conduction during EPS [7][8][9][10][11][12], but little is published about the potential cardiovascular side effects of anesthetic agents during induction and their propensity to induce any type of tachycardia during anesthesia induction.…”

“…This may be due to a higher incidence of hemodynamic disturbances like hypotension, peripheral vasodilatation, a decrease in cardiac output due to depressed myocardial contractility leading to hypotension, or secondary to cardiac conduction tissue sensitization to IH agents. In addition, isoflurane and desflurane are also known to produce a dose dependent increase in heart rate [7][8][9][10][11][12].…”

“…The use of anesthetic agents during these pediatric procedures has been well documented and its use is rarely associated with rare lifethreatening cardiovascular adverse events [1]. The cardiovascular side effects associated with the utilization of anesthetic agents include cardiac arrest, desaturation, hypotension, bradycardia/tachycardia, and changes in cardiomyocyte repolarization time (QT prolongation) resulting in arrhythmias [1][2][3][4][5][6][7][8].…”

In reply: Sevoflurane in patients at risk of ventricular dysrhythmias

“…Therefore, sevoflurane may be safer than other volatile agents for patients at risk of ventricular dysrhythmias. Moreover, propofol inhibits L-type calcium currents (ICa), even at clinical concentrations [4]. Blockage of ICa is known to attenuate the QT interval, prolonging the effects of many drugs [3].…”

Effects of propofol on ischemia-induced ventricular arrhythmias and mitochondrial ATP-sensitive potassium channels

“…Apart from these anesthetic advantages, propofol has non-anesthetic effects such as organ protection against ischemia-reperfusion injury [1,2] . Propofol is usually used for patients with coronary artery disease.…”