Quetiapine and Refractory Hypotension During General Anesthesia in the Operating Room

Poole, Katherine A.; Weber, Nina C.; Aziz, Michael

doi:10.1213/ane.0b013e3182999689

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…However, head-to-head comparisons do not exist between quetiapine and clonidine. 12,21,23 There was a lower percentage of bradycardia in the clonidine group than in quetiapine with a 7.1% absolute risk reduction, which adds to the small number of case reports that describe quetiapine-induced bradycardia 18-20,22. The incidence of QTc prolongation defined by QTc > 500 mSec in our study was 42% in the quetiapine arm compared to 26.3% in the clonidine arm.…”

Section: Discussionmentioning

confidence: 45%

“…2,3 Recent efficacy data discuss these agents' role in the management of delirium, but limited data exist surrounding the safety of using these agents in cardiac surgery ICU patients. [13][14][15][17][18][19][20][21][22][23] The reported incidence of hypotension for clonidine is 44.8% in the normal population and estimated to be 17.8% in critically ill patients, while it is 50% in our study. 25 A meta-analysis estimated the incidence of bradycardia to be 7.9% in critically ill patients.…”

Section: Discussionmentioning

confidence: 61%

“…Clonidine has been reported to induce bradycardia and hypotension, while quetiapine may prolong the QTc. [17][18][19][20][21][22][23] This study aimed to assess the safety of clonidine compared to quetiapine in adult post-cardiac surgery critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Safety of Clonidine and Quetiapine in Post-Cardiac Surgery Intensive Care Unit Patients

Alshaya

Gilmore

Nashett

et al. 2021

Journal of Pharmacy Practice

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Background: Clonidine and quetiapine are frequently used medications in the cardiac surgery intensive care unit (ICU). Objective: The purpose of this study is to assess the impact of clonidine compared to quetiapine on cardiac safety outcomes in adult cardiac surgery ICU patients. Methods: This was a single-center, retrospective observational analysis at a tertiary care, academic medical center. Results: One hundred and sixty-one cardiac surgery patients who were administered clonidine or quetiapine during their ICU stay were included between June 2015 and May 2017. The major endpoint of this study was a cardiac safety composite of bradycardia, hypotension, and QTc prolongation. Minor endpoints included ICU and hospital length of stay, and in-hospital mortality. There were 115 patients included in the clonidine arm and 46 patients in the quetiapine arm. There was no difference between groups with regard to the major endpoint (30.43% vs 33.15%; P < .8). There was a shorter ICU and hospital length of stay in the clonidine arm compared to quetiapine P < .0001. All other endpoints were not statistically significant. Conclusion: Patients who received clonidine tended to have undergone less complex procedures, be younger, and have a lower APACHE II score than patients who received quetiapine. The incidence of composite cardiac safety outcomes was not different in clonidine compared to quetiapine in cardiac surgery ICU patients.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 61%

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Cardiac Safety of Clonidine and Quetiapine in Post-Cardiac Surgery Intensive Care Unit Patients

Alshaya

Gilmore

Nashett

et al. 2021

Journal of Pharmacy Practice

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“…Furthermore, caution must be exercised when using multiple antipsychotics in the perioperative period based on the lessons learned from this case. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Refractory hypotension and coronary artery spasm induced by antipsychotic drugs: A challenging case and treatment consideration: A case report and literature review

Song,

Ji,

Zhao

et al. 2023

Medicine

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Rationale: Coronary artery spasms may result from supply–demand mismatch due to hypotension. Norepinephrine is more effective in ameliorating antipsychotic-induced refractory hypotension. Patient concerns: Postoperative difficult-to-correct hypoperfusion occurs in patients with comorbid depression and coronary spasm; the use of norepinephrine and epinephrine for rapidly raising blood pressure needs to be considered. Diagnoses: Electrocardiogram is an auxiliary tool and Digital Substraction Angiography is the gold standard for the diagnosis. Interventions: Surgery and correct choice of raising blood pressure are the main treatment methods. Outcomes: Hypotension induced by the use of antipsychotics after angiography is difficult to correct with dobutamine, and the above scenario is relatively rare in the clinic, where norepinephrine could be a potential therapeutic option. Lessons: Based on the lessons learnt from this case, caution must be exercised when dealing with patients on multiple antipsychotics during the perioperative period, while pressor-boosting medications should not be limited to conventional drugs such as dopamine. Norepinephrine may be more effective in dealing with difficult-to-correct hypoperfusion.

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“…These effects may impact anesthetic drug requirements and clearance. Lastly, newer atypical antipsychotics have eclipsed haloperidol due to lower risk of tardive dyskinesia in the treatment of schizophrenia, bipolar disorder, or intermittent agitation but may be associated with QTc prolongation, hypotension, anticholinergic symptoms, and prolonged sedation after anesthesia . Some combative or self‐injurious patients may be on scheduled or intermittent benzodiazepine agents to control symptoms, and the anesthesiologist must work closely with the psychiatrist to limit the doses of these agents prior to the procedure to ensure the best conditions for ECT.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic considerations for pediatric electroconvulsive therapy

Franklin

Sobey

Stickles

2017

Pediatric Anesthesia

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Electroconvulsive therapy is being used more frequently in the treatment of many chronic and acute psychiatric illnesses in children. The most common psychiatric indications for pediatric electroconvulsive therapy are refractory depression, bipolar disorder, schizophrenia, catatonia, and autism. In addition, a relatively new indication is the treatment of pediatric refractory status epilepticus. The anesthesiologist may be called upon to assist in the care of this challenging and vulnerable patient population. Unique factors for pediatric electroconvulsive therapy include the potential need for preoperative anxiolytic and inhalational induction of anesthesia, which must be weighed against the detrimental effects of anesthetic agents on the evoked seizure quality required for a successful treatment. Dexmedetomidine is likely the most appropriate preoperative anxiolytic as oral benzodiazepines are relatively contraindicated. Methohexital, though becoming less available at many institutions, remains the gold standard for induction of anesthesia for pediatric electroconvulsive therapy though ketamine, propofol, and sevoflurane are becoming increasingly viable options. Proper planning and communication between the multidisciplinary teams involved in the care of children presenting for electroconvulsive therapy treatments is vital to mitigating risks and achieving the greatest therapeutic benefit.

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Quetiapine and Refractory Hypotension During General Anesthesia in the Operating Room

Cited by 9 publications

References 9 publications

Cardiac Safety of Clonidine and Quetiapine in Post-Cardiac Surgery Intensive Care Unit Patients

Cardiac Safety of Clonidine and Quetiapine in Post-Cardiac Surgery Intensive Care Unit Patients

Refractory hypotension and coronary artery spasm induced by antipsychotic drugs: A challenging case and treatment consideration: A case report and literature review

Anesthetic considerations for pediatric electroconvulsive therapy

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