Sevoflurane and QTc Prolongation

Scuderi, Phillip E.

doi:10.1097/aln.0b013e3181f2b088

Cited by 13 publications

(6 citation statements)

References 36 publications

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“…Torsade de Pointes (TdP), manifested as QT prolongation and polymorphic ventricular tachycardia, stands as the primary cause of drug withdrawals from the market [17,18], and anti-arrhythmic medications such as disopyramide, procainamide, quinidine, and sotalol are reported to have the most cases of drug-induced arrhythmia, including TdP [17,19]. However, in this study, no anti-arrhythmic agents were reported for drug-induced arrhythmia.…”

Section: Discussionmentioning

confidence: 82%

A Real-World Data Driven Pharmacovigilance Investigation on Drug-Induced Arrhythmia Using KAERS DB, a Korean Nationwide Adverse Drug Reporting System

Go,

Kim,

Kim

et al. 2023

Pharmaceuticals

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This study aims to investigate the prevalence and seriousness of drug-induced arrhythmia and to identify predictors associated with the seriousness of arrhythmia. Drug-induced arrhythmia cases reported to the Korean Adverse Event Reporting System Database (KAERS DB) from January 2012 to December 2021 were investigated. A disproportionality test was performed to detect the association of the etiologic medication classes and types, along with patient demographic information, with the seriousness of drug-induced arrhythmia. Logistic regression was performed to investigate the predictors that increase the risk of serious arrhythmia. The most common etiologic agent for drug-induced arrhythmia was sevoflurane, whereas serious arrhythmia was most prevalent with narcotics. Antibiotics (reporting odds ratio (ROR) 4.125; 95% CI 1.438–11.835), chemotherapy (ROR 6.994; 95% CI 2.239–21.542), and iodinated contrast media (ROR 8.273; 95% CI 3.062–22.352) had a strong association with the seriousness of drug-induced arrhythmia. Among numerous etiologic agents, ioversol (ROR 16.490; 95% CI 3.589–75.772) and lidocaine (ROR 12.347; 95% CI 2.996–50.884) were more likely to be reported with serious arrhythmia. Aging and comorbidity, primarily cancer, are the most contributing predictors associated with serious arrhythmia. Further studies on the clinical significance of patient-specific predictors for the increased risk of serious drug-induced arrhythmia are warranted to promote drug safety.

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Section: Discussionmentioning

confidence: 82%

A Real-World Data Driven Pharmacovigilance Investigation on Drug-Induced Arrhythmia Using KAERS DB, a Korean Nationwide Adverse Drug Reporting System

Go,

Kim,

Kim

et al. 2023

Pharmaceuticals

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“…Most patients with sensorineural hearing loss do not have JLNS, yet it seems that repolarization disorders exist at some degrees in all of these patients (32, 33). In addition, JLNS patients could be clinically asymptomatic, with no positive family history and could have QTc duration less than 500 ms in electrophysiological studies (34, 35). In patients undergoing cochlear implantation, anesthetic drugs should be chosen with more caution.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study

et al. 2019

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BackgroundChildren with sensorineural hearing loss are at risk of cardiac electrophysiologic abnormalities. Inhalational Sevoflurane induction in these children can cause QT prolongation.ObjectivesIn order to evaluate the safety of inhalational induction of anesthesia with sevoflurane in children with sensorineural hearing loss, who are candidates for cochlear implant, its electrophysiologic effects was compared with intravenous induction of anesthesia with propofol.MethodsIn this double-blind randomized clinical trial, 61 children aged between one and eighteen years old, who were candidates for cochlear implantation, were randomly allocated to groups receiving anesthesia with sevoflurane (n = 32) or propofol (n = 29) for induction of anesthesia. Two 12-leads ECG were taken from all of patients before and after induction and QTc, Tp-e interval, and JTc were measured and compared.ResultsTwo cases, who had pre-induction QTc longer than 500 ms were excluded from the study. Patients had similar age (102.58 ± 87 versus 101.46 ± 67 months, P = 0.95) and gender (males: 48.3% versus 56.3%, P = 0.53) distribution. The researchers observed significant post induction difference in QTc values between these groups (propofol 422.5 ± 40, sevoflurane 445.0 ± 29, P = 0.016). There was no significant difference in the percent QTc and Tp-e changes in propofol and sevoflurane groups. Greater percentage of patients with increased Tp-e interval (> 100 ms) in the sevoflurane group than the propofol group was also seen. There was no significant long QTc difference (QTc > 500 ms or more than 60 ms increase from baseline) after induction of anesthesia in the sevoflurane group compared to the propofol group (15.6% versus 13.8%, P = 0.84).ConclusionsAfter electrophysiological evaluations in children with sensorineural hearing loss, in patients whose pre-induction QTc is not longer than 500 ms, propofol seems safer than inhalational sevoflurane for induction of anesthesia.

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“…In addition, cardiac surgical patients face simultaneous exposure to inotropes and an ever-growing list of other QTc-prolonging drugs. 16-18 Nevertheless, the role of superimposed genetic effects in modulating inter-individual variability in myocardial repolarization abnormalities following surgery remains unknown, leaving potentially important implications for perioperative risk stratification, surveillance, and management. Most of the genetic diversity in the population is attributable to widespread DNA sequence variants, typically single nucleotide base substitutions (i.e., single nucleotide polymorphisms [SNPs]).…”

Section: Introductionmentioning

confidence: 99%

Interleukin-1β gene variants are associated with QTc interval prolongation following cardiac surgery: a prospective observational study

Kertai

et al. 2016

Can J Anesth/J Can Anesth

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Background We characterized cardiac surgery-induced dynamic changes of the corrected QT (QTc) interval and tested the hypothesis that genetic factors are associated with perioperative QTc prolongation independent of clinical and procedural factors. Methods All study subjects were ascertained from a prospective study of patients who underwent elective cardiac surgery during August 1999 to April 2002. We defined a prolonged QTc interval as >440 msec, measured from 24-hr pre- and postoperative 12-lead electrocardiograms. The association of 37 single nucleotide polymorphisms (SNPs) in 21 candidate genes – involved in modulating arrhythmia susceptibility pathways with postoperative QTc changes–was investigated in a two-stage design with a stage I cohort (n = 497) nested within a stage II cohort (n = 957). Empirical P values (Pemp) were obtained by permutation tests with 10,000 repeats. Results After adjusting for clinical and procedural risk factors, we selected four SNPs (P value range, 0.03-0.1) in stage I, which we then tested in the stage II cohort. Two functional SNPs in the pro-inflammatory cytokine interleukin-1β (IL1β), rs1143633 (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.53 to 0.95; Pemp = 0.02) and rs16944 (OR, 1.31; 95% CI, 1.01 to 1.70; Pemp = 0.04), remained independent predictors of postoperative QTc prolongation. The ability of a clinico-genetic model incorporating the two IL1B polymorphisms to classify patients at risk for developing prolonged postoperative QTc was superior to a clinical model alone, with a net reclassification improvement of 0.308 (P = 0.0003) and an integrated discrimination improvement of 0.02 (P = 0.000024). Conclusion The results suggest a contribution of IL1β in modulating susceptibility to postoperative QTc prolongation after cardiac surgery.

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Sevoflurane and QTc Prolongation

Cited by 13 publications

References 36 publications

A Real-World Data Driven Pharmacovigilance Investigation on Drug-Induced Arrhythmia Using KAERS DB, a Korean Nationwide Adverse Drug Reporting System

A Real-World Data Driven Pharmacovigilance Investigation on Drug-Induced Arrhythmia Using KAERS DB, a Korean Nationwide Adverse Drug Reporting System

Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study

Interleukin-1β gene variants are associated with QTc interval prolongation following cardiac surgery: a prospective observational study

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