The Effects of Spinal Anesthesia on QT Interval in Preeclamptic Patients

Abstract

In this study, we measured the effects of spinal anesthesia on the corrected QT (QTc) interval in women with severe preeclampsia. Twenty-five preeclamptic (preeclamptic group) and 25 healthy pregnant women with normal arterial blood pressure and QTc interval (control group) were enrolled in this prospective, case-controlled study. Arterial blood pressure, heart rate, and QTc interval values were obtained before (baseline value) and at 5, 10, 20, 30, 60, and 120 min after initiation of spinal anesthesia. Total ephedrine dose, time elapsed until sensory block, and Apgar scores were recorded. Prior to spinal anesthesia, QTc interval values were significantly higher in the preeclamptic group (452 +/- 17.5 ms) when compared with that in controls (376 +/- 21.4 ms). Although the QTc interval shortened during spinal anesthesia when compared with baseline value in the preeclamptic group (P < 0.05), it showed no significant change in the control group. In conclusion, the QTc interval may be prolonged in severe preeclamptic patients who have hypertension and hypocalcemia. Spinal anesthesia for cesarean delivery may normalize that prolonged QTc interval due to sympathetic blockade.

Brief review: Anesthetic implications of long QT syndrome in pregnancy

“…44 In a study comparing preeclamptic patients (not LQTS parturients) with healthy controls, the QTc was prolonged prior to induction of spinal anesthesia in the preeclamptic group (452 ± 17.5 msec) but not in the control group (376 ± 21.4 msec). 45 When the spinal was administered the QTc normalized in the preeclamptic group and remained stable in the control group. 45 The authors suggested that the prolonged QTc at baseline was possibly secondary to hypocalcemia and hypertension, or to autonomic imbalance and sympathetic over activity.…”

“…45 When the spinal was administered the QTc normalized in the preeclamptic group and remained stable in the control group. 45 The authors suggested that the prolonged QTc at baseline was possibly secondary to hypocalcemia and hypertension, or to autonomic imbalance and sympathetic over activity. There are no studies investigating the effects of preeclampsia in LQTS, but one should be aware of the potential increase in the QTc.…”

Torsades de pointes au cours d’une anesthésie générale pour césarienne d’urgence dans un contexte de pré-éclampsie

“…1,2 Alors qu'une étude réalisée par Sen et coll. a montré que l'intervalle QT était fréquemment allongé chez les pré-éclamptiques, 3 la survenue de ce type de complication pendant une anesthésie est peu connue. Nous rapportons un cas de torsades de pointes survenant lors d'une anesthésie générale pour césar-ienne dans un contexte de pré-éclampsie sévère.…”

“…La rachianesthésie permet d'éviter l'utilisation de ces agents; elle peut en outre contribuer, grâce au bloc sympathique, à la normalisation d'un QT prolongé chez la pré-éclamptique. 3 Conflit d'intérêt Aucun. …”

El síndrome de QT largo en anestesia. Una revisión a partir de un caso clínico

“…Se ha visto que la anestesia espinal también prolonga el QTc 92 , aunque el bloqueo adrenérgico y la analgesia que provee son deseables. Existen reportes de su uso exitoso en pacientes con LQTS en el campo de la obstetricia [93][94][95][96] . Algunos autores reportan la anestesia epidural como alternativa más segura, aludiendo al hecho de una instauración más gradual, con menor hipotensión, y por tanto, menos probabilidad de uso de drogas simpaticomiméticas 97 .…”