Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.008
Brazilian Journal of Anesthesiology
Scientific Article

The effect of esmolol on corrected-QT interval, corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients taking an angiotensin-converting enzyme inhibitor

Efeito de esmolol sobre o intervalo QT corrigido e alterações da dispersão do intervalo QT corrigido observadas durante a indução da anestesia em pacientes hipertensos que receberam um inibidor da enzima conversora de angiotensina

Zahit Çeker; Suna Akin Takmaz; Bülent Baltaci; Hülya Basar

http://dx.doi.org/10.1016/j.bjane.2014.03.008 Braz J Anesthesiol, vol.65, n1, p.34-40, 2015
PDF English
PDF Português
Downloads: 0
Views: 636

Abstract

BACKGROUND AND OBJECTIVES: The importance of minimizing the exaggerated sympatho-adrenergic responses and QT interval and QT interval dispersion changes that may develop due to laryngoscopy and tracheal intubation during anesthesia induction in the hypertensive patients is clear. Esmolol decreases the hemodynamic response to laryngoscopy and intubation. However, the effect of esmolol in decreasing the prolonged QT interval and QT interval dispersion as induced by laryngoscopy and intubation is controversial. We investigated the effect of esmolol on the hemodynamic, and corrected-QT interval and corrected-QT interval dispersion changes seen during anesthesia induction in hypertensive patients using angiotensin converting enzyme inhibitors. METHODS: 60 ASA I-II patients, with essential hypertension using angiotensin converting enzyme inhibitors were included in the study. The esmolol group received esmolol at a bolus dose of 500 mcg/kg followed by a 100 mcg/kg/min infusion which continued until the 4th min after intubation. The control group received 0.9% saline similar to the esmolol group. The mean blood pressure, heart rate values and the electrocardiogram records were obtained as baseline values before the anesthesia, 5 min after esmolol and saline administration, 3 min after the induction and 30 s, 2 min and 4 min after intubation. RESULTS: The corrected-QT interval was shorter in the esmolol group (p = 0.012), the corrected-QT interval dispersion interval was longer in the control group (p = 0.034) and the mean heart rate was higher in the control group (p = 0.022) 30 s after intubation. The risk of arrhythmia frequency was higher in the control group in the 4-min period following intubation (p = 0.038). CONCLUSION: Endotracheal intubation was found to prolong corrected-QT interval and corrected-QT interval dispersion, and increase the heart rate during anesthesia induction with propofol in hypertensive patients using angiotensin converting enzyme inhibitors. These effects were prevented with esmolol (500 mcg/kg bolus, followed by 100 mcg/kg/min infusion). During induction, the blood pressure tends to decrease with esmolol where care is needed.

Keywords

Esmolol, QT interval, QT dispersion, ACE inhibitor

Resumo

JUSTIFICATIVA E OBJETIVO: É óbvia a importância de minimizar as respostas simpatoadrenérgicas exageradas e o intervalo QT e a dispersão do intervalo QT que podem ocorrer por causa de laringoscopia e intubação traqueal durante a indução da anestesia em pacientes hipertensos. Esmolol diminui a resposta hemodinâmica à laringoscopia e à intubação. Porém, o efeito de esmolol sobre a redução do intervalo QT prolongado e a dispersão do intervalo QT induzida pela laringoscopia e intubação é controverso. Pesquisamos o efeito de esmolol sobre a hemodinâmica e o intervalo QT corrigido e as alterações da dispersão do intervalo QT observadas durante a indução da anestesia em pacientes hipertensos que receberam inibidores da enzima conversora de angiotensina (IECA). MÉTODOS: Foram incluídos no estudo 60 pacientes, estado físico ASA I-II, com hipertensão arterial essencial e que receberam IECA. O grupo esmolol recebeu uma dose em bolus de 500 mcg kg-1, seguida por infusão contínua de 100 mcg kg-1 min-1 até o quarto minuto após a intubação. O grupo controle recebeu solução salina a 0,9%, semelhantemente ao grupo esmolol. Os valores da pressão arterial média e da frequência cardíaca e os registros do eletrocardiograma foram obtidos durante a fase inicial pré-anestesia, cinco minutos após a administração de esmolol e solução salina, três minutos após a indução e 30 segundos, dois minutos e quatro minutos após a intubação. RESULTADOS: O intervalo QT corrigido foi menor no grupo esmolol (p = 0,012), o intervalo de dispersão do intervalo QT corrigido foi maior no grupo controle (p = 0,034) e a frequência cardíaca média foi maior no grupo controle (p = 0,022) 30 segundos após a intubação. O risco da frequência de arritmia foi maior no grupo controle no quarto minuto após a intubação (p = 0,038). CONCLUSÃO: Descobrimos que a intubação traqueal prolonga o intervalo e a dispersão do intervalo QT corrigido e aumenta a frequência cardíaca durante a indução da anestesia com propofol em pacientes hipertensos que receberam IECA. Esses efeitos foram prevenidos com esmolol (bolus de 500 mcg kg-1, seguido de 100 mcg kg-1 min-1 de infusão). Durante a indução, a pressão tende a diminuir com esmolol. Portanto, cuidados são necessários.

Palavras-chave

Esmolol, Intervalo QT, Dispersão do QT, Inibidores da Enzima Conversora de Angiotensina (ECA)

References

Chiang CE. Congenital and acquired long QT syndrome. Current concepts and management. Cardiol Rev.. ;12:234-222.

Okin PM, Devereux RB, Howard BV. Assessment of QT interval and QT dispersion for prediction of all cause and cardiovascular mortality in American Indians. The strong heart study. Circulation.. ;101:61-66.

Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anesthesia. Br J Anaesth.. ;90:366-349.

Ay B, Fak AS, Toprak A. QT dispersion increases during intubation in patients with coranary artery diseases. J Electrocardiol.. ;36:99-104.

Thomson IR. The haemodynamic response to intubation: a perspective. Can J Anaesth.. ;36:367-369.

Kaplan JD, Schuster DP. Physiological consequences of tracheal intubation. Clin Chest Med.. ;12:432-425.

Hawel SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth.. ;92:570-583.

Prakash ES, Madanmohan Sethuraman KR, Narayan SK. Cardiovascular autonomic regulation in subjects with normal blood pressure, high-normal blood pressure and recent-onset hypertension. Clin Exp Pharmacol Physiol.. ;32:494-488.

Morgan GE, Mikhail MS. Anaesthesia for patients with cardiovascular disease. Clinical anesthesiology. :389-395.

Messerli FH. Hypertension and sudden cardiac death. Am J Hypertens.. ;12:188-181.

Galinier M, Balanescu S, Fourcade J. Prognostic value of ventricular arrhythmias in systemic hypertension. J Hypertens.. ;15:1783-1779.

Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the heart rate, arterial pressure and electrocardiographic changes during laryngomicroscopy. Acta Anaesth Scand.. ;41:371-375.

Figueredo E, Garcia-Fuentes EM. Assessment of the efficacy of esmolol on the haemodynamic changes induced by laryngoscopy and tracheal intubation: a meta-analysis. Acta Anaesthesiol Scand.. ;45:1011-1022.

Pigott DW, Nagle C, Allman K. Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements. Br J Anaesth.. ;83:715-720.

Coriat P, Richer C, Douraki T. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology.. ;81:229-307.

Saarnivaara L, Klemola UM, Lindgren L. QT interval of the ECG, heart rate and arterial pressure using propofol, methohexital or midazolam for induction of anaesthesia. Acta Anaesthesiol Scand.. ;34:281-276.

McConachie I, Keaveny JP, Healy TE. Effect of anaesthesia on the QT interval. Br J Anaesth.. ;63:560-558.

Kleinsasser A, Kuenszberg E, Loeckinger A. Sevoflurane, but not propofol, significantly prolongs the Q-T interval. Anesth Analg.. ;90:25-27.

Michaloudis DG, Kanakoudis FS, Petrou AM. The effects of midazolam or propofol followed by suxamethonium on the QT interval in humans. Eur J Anaesthesiol.. ;13:364-368.

Robinson BJ, Ebert TJ, O'Brien TJ. Mechanisms whereby propofol mediates peripheral vasodilation in humans. Sympathoinhibition or direct vascular relaxation? Anesthesiology.. ;86:64-72.

Hoka S, Yamaura K, Takenaka T. Propofol-induced increase in vascular capacitance is due to inhibition of sympathetic vasoconstrictive activity. Anesthesiology.. ;89:1500-1495.

Tramer MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth.. ;78:642-651.

Korpinen R, Klemola UM, Simola M. The electrocardiographic and hemodynamic effect of metohexital and propofol with and without esmolol. Acta Anaesthesiol Scand.. ;50:188-192.

Weisenberg M, Sessler DI, Tavdi M. Dose-dependent hemodynamic effects of propofol induction following brotizolam premedication in hypertensive patients taking angiotensinconverting enzyme inhibitors. J Clin Anesth.. ;22:195-190.

Passino C, Magagna A, Conforti F. Ventricular repolarization is prolonged in nondipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. J Hypertens.. ;21:451-445.

Oikarinen L, Viitasalo M, Toivonen L. Anglo-Scandinavian Cardiac Outcomes Trial Comparative effects of atenolol-based and amlodipine-based antihypertensive therapy on QT dispersion in hypertensive subjects. J Hum Hypertens.. ;15 Suppl 1:45-43.

Galetta F, Franzoni F, Magagna A. Effect of nebivolol on QT dispersion in hypertensive patients with left ventricular hypertrophy. Biomed Pharmacother.. ;59:19-15.

Korpinen R, Saarnivaara L, Siren K. Modification of the haemodynamic responses to induction of anaesthesia and tracheal intubation with alfentanil, esmolol and their combination. Can J Anaesth.. ;42:304-298.

Korpinen R, Saarnivaara L, Siren K. QT interval of the ECG, heart rate and arterial pressure during anaesthetic induction: comparative effects of alfentanil and esmolol. Acta Anaesthesiol Scand.. ;39:809-813.

Korpinen R, Simola M, Saarnivaara L. Effect of esmolol on the hemodynamic and electrocardiographic changes during laryngomicroscopy under propofol-alfentanil anesthesia. Acta Anaesthesiol Belg.. ;49:132-123.

Erdil F, Demirbilek S, Begec Z. The effect of esmolol on the QTc interval during induction of anaesthesia in patients with coronary artery disease. Anaesthesia.. ;64:250-246.

Kaneko M, Yamaguchi S, Hamaguchi S. Effects of landiolol on QT interval and QT dispersion during induction of anesthesia using computerized measurement. J Clin Anesth.. ;21:555-561.

5dd462020e88259f68f1efda rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections