Sustained prolongation of the QTc interval after anesthesia with sevoflurane in infants during the first 6 months of life

Sevoflurane, an inhalational anesthetic frequently administered to infants, prolongs the QT interval of the electrocardiogram in adults. A long QT interval resulting in fatal arrhythmia may also be responsible for some cases of sudden death in infants. As the QT interval increases during the second...

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Veröffentlicht in:Anesthesiology (Philadelphia) 2003-03, Vol.98 (3), p.639-642
Hauptverfasser: LOECKINGER, Alex, KLEINSASSER, Axel, MAIER, Stephan, FURTNER, Bernhard, KELLER, Christian, KUEHBACHER, Gabriele, LINDNER, Karl H
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container_title Anesthesiology (Philadelphia)
container_volume 98
creator LOECKINGER, Alex
KLEINSASSER, Axel
MAIER, Stephan
FURTNER, Bernhard
KELLER, Christian
KUEHBACHER, Gabriele
LINDNER, Karl H
description Sevoflurane, an inhalational anesthetic frequently administered to infants, prolongs the QT interval of the electrocardiogram in adults. A long QT interval resulting in fatal arrhythmia may also be responsible for some cases of sudden death in infants. As the QT interval increases during the second month of life and returns to the values recorded at birth by the sixth month, we evaluated the effect of sevoflurane on the QT interval during and after anesthesia in this particular population. In this prospective two-group trial we examined pre-, peri-, and postoperative electrocardiograms of 36 infants aged 1 to 6 months scheduled for elective inguinal or umbilical hernia repair. Anesthesia was induced and maintained with either sevoflurane, or the well-established pediatric anesthetic halothane. Heart rate corrected (c) QTc and JTc interval (indicator of intraventricular conduction delays) were recorded from electrocardiograms before and during anesthesia, and at 60 min after emergence from anesthesia. Prolonged QTc was observed during sevoflurane anesthesia (mean [+/-SD], 473 +/- 19 ms, P< 0.01). Sixty minutes after emergence from anesthesia, QTc was still prolonged (433 +/- 15 ms) in infants treated with sevoflurane compared with those treated with halothane (407 +/- 33 ms, P< 0.01). Analogous differences were found for the JTc interval. Despite a shorter elimination time than better known inhalational anesthetics, sevoflurane induction and anesthesia results in sustained prolongations of QTc and JTc interval in infants in the first 6 months of life. Electrocardiogram monitoring until the QTc interval has returned to preanesthetic values may increase safety after sevoflurane anesthesia.
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A long QT interval resulting in fatal arrhythmia may also be responsible for some cases of sudden death in infants. As the QT interval increases during the second month of life and returns to the values recorded at birth by the sixth month, we evaluated the effect of sevoflurane on the QT interval during and after anesthesia in this particular population. In this prospective two-group trial we examined pre-, peri-, and postoperative electrocardiograms of 36 infants aged 1 to 6 months scheduled for elective inguinal or umbilical hernia repair. Anesthesia was induced and maintained with either sevoflurane, or the well-established pediatric anesthetic halothane. Heart rate corrected (c) QTc and JTc interval (indicator of intraventricular conduction delays) were recorded from electrocardiograms before and during anesthesia, and at 60 min after emergence from anesthesia. Prolonged QTc was observed during sevoflurane anesthesia (mean [+/-SD], 473 +/- 19 ms, P&lt; 0.01). Sixty minutes after emergence from anesthesia, QTc was still prolonged (433 +/- 15 ms) in infants treated with sevoflurane compared with those treated with halothane (407 +/- 33 ms, P&lt; 0.01). Analogous differences were found for the JTc interval. Despite a shorter elimination time than better known inhalational anesthetics, sevoflurane induction and anesthesia results in sustained prolongations of QTc and JTc interval in infants in the first 6 months of life. Electrocardiogram monitoring until the QTc interval has returned to preanesthetic values may increase safety after sevoflurane anesthesia.</description><identifier>ISSN: 0003-3022</identifier><identifier>EISSN: 1528-1175</identifier><identifier>DOI: 10.1097/00000542-200303000-00011</identifier><identifier>PMID: 12606907</identifier><identifier>CODEN: ANESAV</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott</publisher><subject>Anesthetics, Inhalation - pharmacology ; Anesthetics. 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subjects Anesthetics, Inhalation - pharmacology
Anesthetics. Neuromuscular blocking agents
Biological and medical sciences
Electrocardiography - drug effects
Female
Halothane - pharmacology
Humans
Infant
Infant, Newborn
Male
Medical sciences
Methyl Ethers - pharmacokinetics
Methyl Ethers - pharmacology
Neuropharmacology
Pharmacology. Drug treatments
Prospective Studies
Sevoflurane
Time Factors
title Sustained prolongation of the QTc interval after anesthesia with sevoflurane in infants during the first 6 months of life
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