Evaluation of QT Interval of Patients Using Muscle Relaxants Under General Anesthesia, Randomized Clinical Trial
Öz
Objective: The aim of the study was to investigate the effects of rocuronium, mivacurium, and atracurium on arrhythmia markers, QT interval, and QT dispersion (QTd).
Method: Ninety patients scheduled for septorhinoplasty were randomly assigned to one of three groups of 30. During the induction of anesthesia, muscle relaxants of 0.6 mg/kg rocuronium in Group R, 0.2 mg/kg mivacurium in Group M, and 0.5 mg/kg atracurium in Group A were employed. Mean blood pressure (MAP), heart rate (HR), and electrocardiogram (ECG) values were measured before induction of anesthesia (T0), immediately after induction of anesthesia (T1), at 1 minute (T2), 5 minutes (T3), 10 minutes (T4) and 15 minutes (T5) after muscle relaxant administration, and QT, corrected QT (QTc), QTd and corrected QTd (QTcd) intervals were recorded.
Results: When the groups were compared in terms of QTcd values, the difference between mivacurium and atracurium was significant in terms of T5 values, and atracurium (T5) QTcd was found to be shorter (p<0.05). Group M had 5 of the 6 measures with pathological QTc prolongation.
Conclusions: Because the prevalence of pathological QTc is greater in mivacurium, further clinical trials should be conducted to challenge the use of mivacurium in individuals with a long QT interval.
Anahtar Kelimeler
atracurium mivacurium rocuronium electrocardiography qt interval
Kaynakça
- 1. Kaplan JA, Thys DM. Electrocardiography. In: Miller RD Anesthesia Vol.1 3th ed. Churchill Livingstone 1990:1101-1127.
- 2. Davies JM. Complication of general anaesthesia. In: Nimmo WS, Smith G. AnesthesiaVol. 1 Blackwell Scientific Publications 1989:502-521.
- 3. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003;90:349–66.
- 4. Al-Refai A, Gunka V, Douglas J. Spinal anesthesia for Cesarean section in a parturient with long QT syndrome. Can J Anaesth. 2004;51:993-6.
- 5. Arildsen H, May O, Christian EH, et al. Increased QT dispersion in patients with insulin dependent diabetes mellitus. International Journal of Cardiology 1999;71:235-42.
- 6. Sharma, E, Gannon, S, McCauley, B, Chu, AF. Sudden death in a patient with long QT syndrome presenting with an epileptic phenotype. AnnNoninvasiveElectrocardiol. 2020; 25:e12753. https://doi.org/10.1111/anec.12753
- 7. James Winter, Michael J. Tipton, Michael J. Shattock, Autonomic conflict exacerbates long QT associated ventricular arrhythmias, Journal of Molecular and Cellular Cardiology, 2018;116:145-154, https://doi.org/10.1016/j.yjmcc.2018.02.001.
- 8. Yıldırım H, Adanır T, Atay A, vd. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesth 2004;21:566-570.
- 9. Pentti M. Rautaharju, Jay W. Mason, Toshio Akiyama, New age- and sex-specific criteria for QT prolongation based on rate correction formulas that minimize bias at the upper normal limits. International Journal of Cardiology,2014;174(3):535-540
- 10. Andreoli T, Bennett CJ, Carpenter CJ, et al. Cecil Essentials of Medicine, Elektrokardiografi,1993:21-23.
- 11. Demirtaş AO, Urgun OD. Can QT interval prolongation or dispersion detected in a positive exercise ECG test predict critical coronary artery disease?. Arch Med Sci Atheroscler Dis. 2019;4:e7-e12. Published 2019 Mar 4. doi:10.5114/amsad.2019.83299
- 12. Avcı O, Gürsoy S, Kaygusuz K, Kol İO, Düger C, İsbir, AC, Mimaroğlu MC. The effects of sedatıve agents used ın ıntensıve care unıt on qt ınterval. Cumhuriyet Medical Journal 2017;39(1):417-429. DOI: 10.7197/cmj.v39i1.5000208784
- 13. Safaeian R, Hassani V, Mohseni M, et al. Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study. Anesth Pain Med. 2019;9(4):e88805. Published 2019 Aug 5. doi:10.5812/aapm.88805
- 14. Tominaga S, Terao Y, Urabe S, et al. The effects of intravenous anesthetics on QT interval during anesthetic induction with desflurane. JA Clin Rep 4, 57 (2018). https://doi.org/10.1186/s40981-018-0195-9
- 15. Chang DJ, Kweon TD, Nam SB, Lee JS, Shin CS, Park CH, Han DW. Effects of fentanyl pretreatment on the QTc interval during propofol induction. Anaesthesia 2008;63:1056-1060. https://doi.org/10.1111/j.1365-2044.2008.05559.x
- 16. Ağdanlı D, Öztürk T, Ütük O, vd. Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery Turk J Anaesth Reanim 2014;42(5):245-50.
- 17. Gürsoy S, Bagcivan I, Durmuş N, vd. Investigation of the cardiac effects of pancuronium, rocuronium, vecuronium, and mivacurium on the isolated rat atrium, Curr Ther Res Clin Exp. 2011;72(5):195-203.
Öz
Kaynakça
- 1. Kaplan JA, Thys DM. Electrocardiography. In: Miller RD Anesthesia Vol.1 3th ed. Churchill Livingstone 1990:1101-1127.
- 2. Davies JM. Complication of general anaesthesia. In: Nimmo WS, Smith G. AnesthesiaVol. 1 Blackwell Scientific Publications 1989:502-521.
- 3. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003;90:349–66.
- 4. Al-Refai A, Gunka V, Douglas J. Spinal anesthesia for Cesarean section in a parturient with long QT syndrome. Can J Anaesth. 2004;51:993-6.
- 5. Arildsen H, May O, Christian EH, et al. Increased QT dispersion in patients with insulin dependent diabetes mellitus. International Journal of Cardiology 1999;71:235-42.
- 6. Sharma, E, Gannon, S, McCauley, B, Chu, AF. Sudden death in a patient with long QT syndrome presenting with an epileptic phenotype. AnnNoninvasiveElectrocardiol. 2020; 25:e12753. https://doi.org/10.1111/anec.12753
- 7. James Winter, Michael J. Tipton, Michael J. Shattock, Autonomic conflict exacerbates long QT associated ventricular arrhythmias, Journal of Molecular and Cellular Cardiology, 2018;116:145-154, https://doi.org/10.1016/j.yjmcc.2018.02.001.
- 8. Yıldırım H, Adanır T, Atay A, vd. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesth 2004;21:566-570.
- 9. Pentti M. Rautaharju, Jay W. Mason, Toshio Akiyama, New age- and sex-specific criteria for QT prolongation based on rate correction formulas that minimize bias at the upper normal limits. International Journal of Cardiology,2014;174(3):535-540
- 10. Andreoli T, Bennett CJ, Carpenter CJ, et al. Cecil Essentials of Medicine, Elektrokardiografi,1993:21-23.
- 11. Demirtaş AO, Urgun OD. Can QT interval prolongation or dispersion detected in a positive exercise ECG test predict critical coronary artery disease?. Arch Med Sci Atheroscler Dis. 2019;4:e7-e12. Published 2019 Mar 4. doi:10.5114/amsad.2019.83299
- 12. Avcı O, Gürsoy S, Kaygusuz K, Kol İO, Düger C, İsbir, AC, Mimaroğlu MC. The effects of sedatıve agents used ın ıntensıve care unıt on qt ınterval. Cumhuriyet Medical Journal 2017;39(1):417-429. DOI: 10.7197/cmj.v39i1.5000208784
- 13. Safaeian R, Hassani V, Mohseni M, et al. Comparison of the Effects of Propofol and Sevoflurane on QT Interval in Pediatrics Undergoing Cochlear Implantation: A Randomized Clinical Trial Study. Anesth Pain Med. 2019;9(4):e88805. Published 2019 Aug 5. doi:10.5812/aapm.88805
- 14. Tominaga S, Terao Y, Urabe S, et al. The effects of intravenous anesthetics on QT interval during anesthetic induction with desflurane. JA Clin Rep 4, 57 (2018). https://doi.org/10.1186/s40981-018-0195-9
- 15. Chang DJ, Kweon TD, Nam SB, Lee JS, Shin CS, Park CH, Han DW. Effects of fentanyl pretreatment on the QTc interval during propofol induction. Anaesthesia 2008;63:1056-1060. https://doi.org/10.1111/j.1365-2044.2008.05559.x
- 16. Ağdanlı D, Öztürk T, Ütük O, vd. Effects of High-Dose Rocuronium on the QTc Interval During Anaesthesia Induction in Patients Undergoing Coronary Artery Bypass Graft Surgery Turk J Anaesth Reanim 2014;42(5):245-50.
- 17. Gürsoy S, Bagcivan I, Durmuş N, vd. Investigation of the cardiac effects of pancuronium, rocuronium, vecuronium, and mivacurium on the isolated rat atrium, Curr Ther Res Clin Exp. 2011;72(5):195-203.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Cerrahi Tıp Bilimleri Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Mart 2022 |
| Kabul Tarihi | 21 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022Cilt: 44 Sayı: 1 |