Propofol-associated QTc prolongation

Abstract

Objectives: Propofol is a preferred agent for sedation in patients in the intensive care unit (ICU) due, in part, to its established safety profile. Despite this, recent case reports have suggested a potential for prolongation of the corrected QT interval (QTc) in ICU patients receiving propofol, though limited empirical work has been conducted to evaluate this association. As such, the purpose of this study was to assess the relationship between propofol infusion and QTc prolongation in a historical cohort of ICU patients. Methods: A single-center, historical, observational, pre-post cohort analysis of medical records from admitted patients ⩾18 years old with cardiovascular disease was conducted, involving cases who received propofol infusion for ⩾3 hours with sequential electrocardiogram monitoring from 2006 to 2012. A multivariable, generalized linear model regression was employed to assess the primary outcome of on-propofol QTc interval (QTc 2 ), controlling for various demographic and clinical factors. Results: A total of 96 patients met inclusion criteria, averaging 56.1 ± 14.1 years of age and 86.1 ± 25.0 kg, with 37.5% being female. A mean prolongation in QTc interval of 30.4 ± 55.5 ms (p < 0.001) was observed during the propofol infusion, with 43.8% of cases exhibiting an on-infusion QTc 2 of ⩾ 500 ms. Regression analyses suggested that prolongation in on-propofol QTc was independently associated with baseline QTc interval and amiodarone use, while weight as inversely associated with QTc 2 (p < 0.05). Conclusion:This historical cohort analysis of adult ICU patients receiving propofol suggests that on-infusion QTc prolongation was associated with increasing baseline QTc interval and with amiodarone use. Further research is needed to evaluate the clinical significance and cause-and-effect relationship between potential QTc changes and propofol use in the ICU.

Comparison of Cognitive Impairments After Intensive Care Unit Sedation Using Dexmedetomidine and Propofol Among Older Patients

“…The ICU setting is full of severely ill patients, who often require complex medications due to the altered drug pharmacokinetics and adverse drug events . Sedation management is an important component of ICU medication care.…”

“…Sedation management is an important component of ICU medication care. The goals of sedation are the maintenance of safety and comfort of patients, which helps to reduce patients’ suffering; risk of death; length of hospital stay; and hospital cost . The risks of a therapeutic sedation strategy include short‐term hemodynamic and respiratory depression and long‐term neurotoxicity, which impairs the neurocognitive functions of patients .…”

“…The ICU setting is full of severely ill patients, who often require complex medications due to the altered drug pharmacokinetics and adverse drug events. 11 Sedation management is an important component of ICU medication care. The goals of sedation are the maintenance of safety and comfort of patients, 12 which helps to reduce patients' suffering; risk of death; length of hospital stay; and hospital cost.…”

“…The goals of sedation are the maintenance of safety and comfort of patients, 12 which helps to reduce patients' suffering; risk of death; length of hospital stay; and hospital cost. 11 The risks of a therapeutic sedation strategy include short-term hemodynamic and respiratory depression and long-term neurotoxicity, which impairs the neurocognitive functions of patients. 13 Transient cognitive dysfunction after general anesthesia is a frequent phenomenon among elderly patients.…”

Comparison of Overridden Medication-related Clinical Decision Support in the Intensive Care Unit between a Commercial System and a Legacy System

“…There was no DDI alert for propofol and QTc-prolonging medications in the legacy database. There is conflicting data on the clinical significance of this potential interaction [17,18]. Studies evaluating the incidence of clinically significant QTc prolongation (QTc > 500 ms or QTc increase from baseline > 60 ms) in the ICU have found rates up to 48%, depending on the ICU studied [19,20].…”