Sevoflurane Causes Greater QTc Interval Prolongation in Elderly Patients than in Younger Patients

Nakao, Shinichi; Hatano, Kiyohiko; Sumi, Chisato; Masuzawa, Munehiro; Sakamoto, Sachiyo; Ikeda, Shunichiro; Shingu, Koh

doi:10.1213/ane.0b013e3181cde713

Cited by 37 publications

(36 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, these clinical studies targeted small numbers of patients and did not include those under general anesthesia. General anesthesia is a risk factor for QT interval prolongation because of the use of QT‐prolonging drugs or possible bradycardia in patients with preexisting comorbidities or electrolyte imbalances . Different from the first generation 5‐HT 3 receptor antagonists that are recommended for use at the end of surgery, palonosetron is recommended for use at anesthesia induction because of a slower onset of action .…”

mentioning

confidence: 99%

“…General anesthesia is a risk factor for QT interval prolongation because of the use of QT-prolonging drugs or possible bradycardia in patients with preexisting comorbidities or electrolyte imbalances. [14][15][16] Different from the first generation 5-HT 3 receptor antagonists that are recommended for use at the end of surgery, palonosetron is recommended for use at anesthesia induction because of a slower onset of action. 17 Furthermore, to our knowledge, there have been no studies regarding the effects of palonosetron on perioperative cardiovascular complications in large numbers of patients under general anesthesia in real clinical practice.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

Min

Kim

Jung

et al. 2015

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

We retrospectively investigated whether palonosetron administered during the induction of general anesthesia is associated with an increased risk of perioperative cardiovascular complications in a single tertiary center cohort consisting of 4,517 palonosetron-exposed patients and 4,517 propensity score-matched patients without palonosetron exposure. The primary endpoint was a composite of perioperative cardiovascular complications, including intraoperative cardiac arrhythmia, intraoperative cardiac death, and myocardial injury within the first postoperative week, and there was no significant difference between the groups (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 0.92-1.19). As secondary endpoints, intraoperative cardioversion, cardiac compression, use of cardiovascular drugs, postoperative hospital stay, and in-hospital mortality showed no differences between the groups. However, the palonosetron group showed decreased intraoperative hypotension (OR = 0.88; 95% CI = 0.79-0.97) and length of postoperative intensive care unit (ICU) stay (4.26 ± 9.86 vs. 6.14 ± 16.75; P = 0.026). Palonosetron did not increase the rate of perioperative cardiovascular complications, and can therefore be used safely during anesthetic induction.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

Min

Kim

Jung

et al. 2015

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

show abstract

“…Class IA and III antiarrhythmic agents should be avoided because of a potential to prolong QTc [37][38][39] . Many of the anesthetic agents prolong QTc (inhaled anesthetics, droperidol, ondansetron, and succinylcholine) and should be administered with care [40][41][42][43] . Prolongation of the QT interval, intraventricular conduction disturbances, heart block, and ventricular bigeminy can occur with propoxyphene.…”

Section: Intraoperative Managementmentioning

confidence: 99%

The Anesthetic Implications of Opioid Addiction

Lewis

Souki

2011

Perioperative Addiction

View full text Add to dashboard Cite

“…5,6 There is a strong correlation between QTc prolongation and the risk for torsade de pointes, but there is no absolute QTc threshold above which torsade de pointes routinely occurs. Several drugs that are routinely administered in the perioperative setting, such as antibiotics, sevoflurane, 7–10 or ondansetron 11–13 have been shown to cause QTc interval prolongation. Furthermore, in a recent study we found that the 80% of patients undergoing noncardiac surgery under general anesthesia developed postoperative QTc prolongation with a median increase of 23ms.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Torsade de Pointes

Johnston¹,

Pal²,

Nägele³

2013

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

Background Torsade de pointes is a rare, but potentially fatal arrhythmia. More than 40 cases of perioperative torsade de pointes have been reported in the literature; however, the current evidence regarding this complication is very limited. To improve our understanding we performed a systematic review and meta-analysis of all published case reports of perioperative torsade de pointes. Methods MEDLINE was systematically searched for cases of perioperative torsade de pointes. We included patients of all age groups, and cases that occurred from the immediate preoperative period to the third postoperative day. Patient and case characteristics as well as QT interval data were extracted. Results Forty-six cases of perioperative torsade de pointes were identified; 29 occurred in women (67%) and two episodes were fatal (case fatality rate: 4%). Craniotomies and cardiac surgery accounted for 40% of all cases. Preceding events identified by the authors were hypokalemia (12/46, 26%; 99%CI 9% – 43%) and bradycardia (7/46, 15%; 99%CI 2% – 28%). Drugs were implicated in approximately one-third of the events (14/46, 30%; 99% CI 13% – 48%). The mean QTc at baseline was 457 ± 67ms (min. 320ms; max. 647ms; data available in 27/46 patients). At the time of the event, the mean QTc increased to 575 ± 77ms (min. 413ms; max. 766ms; data available in 33/46 patients). On average, QTc increased by +118ms (99% CI 70 – 166 ms; p< 0.001) between baseline and after the torsade de pointes event. All patients, except for two, had a substantial prolongation of their QTc interval at the time of the event. Conclusions This systematic review identified several common risk factors for perioperative torsade de pointes. Given the nearly uniform presence of a substantial QTc interval prolongation at the time of a torsade de pointes episode, increased vigilance for perioperative QTc interval prolongation may be warranted.

show abstract

Sevoflurane Causes Greater QTc Interval Prolongation in Elderly Patients than in Younger Patients

Cited by 37 publications

References 30 publications

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

Effects of Palonosetron on Perioperative Cardiovascular Complications in Patients Undergoing Noncardiac Surgery With General Anesthesia: A Retrospective Cohort Study

The Anesthetic Implications of Opioid Addiction

Perioperative Torsade de Pointes

Contact Info

Product

Resources

About