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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2001 September;67(9):637-40


language: English

Effects of sevoflurane versus propofol on QT interval

Paventi S., Santevecchi A., Ranieri R.

From the Department of Anesthesiology and Intensive Care Medicine Catholic University of Sacred Heart - Roma


Back­ground. Pro­lon­ga­tion of the QT inter­val is an alter­a­tion of the elec­tro­car­di­o­gram (ECG) ­that may ­result in a poten­tial­ly dan­ger­ous poly­mor­phic ven­tric­u­lar tach­y­car­dia ­known as “tor­sade de ­pointes”. Mich­a­lou­dis et al. inves­ti­gat­ed the ­effect of iso­flu­rane and hal­o­thane on the QT inter­val in pre­med­i­cat­ed and non pre­med­i­cat­ed chil­dren, and in pre­med­i­cat­ed ­adults. Iso­flu­rane sig­nif­i­cant­ly pro­longed the QTc inter­val, in con­trast to hal­o­thane, ­which short­ened the QTc inter­val.
The aim of the ­study was to eval­u­ate the ­effect of sevof­lu­rane on the QT inter­val in ­patients under­go­ing non-car­diac sur­gery.
Meth­ods. One hun­dred and ­eighty ­patients clas­si­fied as ASA phys­i­cal stat­us I-III ­were ­enrolled and 102 ­were exclud­ed. ­Patients had ­been sched­uled for elec­tive non car­diac sur­gery. Exclu­sions cri­te­ria ­were: car­di­o­vas­cu­lar impair­ment or chron­ic obstruc­tive ­lung dis­ease, med­i­ca­tion affect­ing QT inter­val, and an abnor­mal pro­lon­ga­tion of the QTc inter­val (440 ms). The ­patients ­were ­then ran­dom­ly allo­cat­ed to one of two ­groups, one receiv­ing sevof­lu­rane anes­the­sia and the oth­er receiv­ing pro­pof­ol anes­the­sia. In all ­patients, a 12 ­lead ECG was record­ed ­before sur­gery, ­after intu­ba­tion, ­after extu­ba­tion. The inves­ti­ga­tors read­ing the ECG ­were blind­ed to the ­type of induc­tion and anes­the­sia ­used. The fol­low­ing var­i­ables ­were record­ed or cal­cu­lat­ed: ­heart ­rate, P-R inter­val, QRS inter­val, QT inter­val, QTc inter­val accord­ing to ­Bazett’s for­mu­la, sys­tol­ic, dia­stol­ic and ­mean ­blood pres­sure.
­Results. The sevof­lu­rane sig­nif­i­cant­ly pro­longs the QT and the QTc inter­val, where­as the induc­tion and ­total intra­ve­nous anes­the­sia ­with pro­pof­ol sig­nif­i­cant­ly short­ens the QT but not the QTc inter­val.
Con­clu­sions. The ­amount the sevof­lu­rane-asso­ciat­ed QT pro­lon­ga­tion may pos­sibly be of clin­i­cal sig­nif­i­cance in ­some ­patients pre­sent­ing ­long QT syn­drome, hypo­ka­le­mia, or in pres­ence of oth­er ­agents or fac­tors ­that length­en QT.

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