Anestesia e síndrome do QT longo

Michelle Nacur Lorentz; Flávio Gouveia Camelo Ramiro

doi:10.1590/S0034-70942007000500010

Review Article

Anestesia e síndrome do QT longo

Anesthesia and the long QT syndrome

Michelle Nacur Lorentz; Flávio Gouveia Camelo Ramiro

http://dx.doi.org/10.1590/S0034-70942007000500010 Braz J Anesthesiol, vol.57, n5, p.543-548, 2007

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Resumo

JUSTIFICATIVA E OBJETIVOS: As disritmias cardíacas são fatores importantes de morbimortalidade no período perioperatório. Dentre as causas de disritmias, a síndrome do QT longo, tanto em sua forma genética como adquirida deve ser lembrada, já que muitos fármacos usados em anestesia, bem como ocorrências no período perioperatório podem prolongar o intervalo QT e precipitar disritmias cardíacas potencialmente malignas. CONTEÚDO: Revisão da síndrome do QT longo (LQTS), abordando suas causas e sua definição, assim como os mecanismos da doença. Além de citar vários fármacos implicados no prolongamento do intervalo QT, as abordagens anestésicas mais adequadas para os pacientes afetados são sugeridas. CONCLUSÃO: A síndrome do QT longo, possível causa de morbimortalidade intra e pós-operatória, pode estar relacionada com fármacos utilizados durante anestesia. Essa condição demanda conhecimento do anestesiologista a fim de evitar desfecho desfavorável do ato operatório.

Palavras-chave

DOENÇAS, Cardíaca, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Cardiac arrhythmias are important factors of perioperative morbidity and mortality. Among the causes of arrhythmias, the long QT syndrome, both in the genetic and acquired types, should be remembered since several drugs used in anesthesia, as well as in the perioperative period, can prolong the QT interval and trigger potentially malignant arrhythmias. CONTENTS: A review of the long QT syndrome (LQTS), discussing its causes and definition, as well as the mechanisms of the disease. Besides mentioning several drugs implicated in prolonging the QT interval, and the most adequate anesthetic approaches to affected patients are recommended. CONCLUSION: The long QT syndrome, possible cause of intra- and postoperative morbidity and mortality, can be related to drugs used during anesthesia. The anesthesiologist should have knowledge of this syndrome, in order to avoid an unfavorable outcome.

Keywords

DISEASES, Cardiac, DRUGS

Referências

Wisely NA, Shipton EA. Long QT syndrome and anaesthesia. Eur J Anaesthesiol. 2002;19:853-859.

Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920;7:353-370.

Li H, Fuentes-Garcia J, Towbin JA. Current concepts in long QT syndrome. Pediatric Cardiol. 2000;21:542-550.

Towbin JA, Wang Z, Li H. Genotype and severity of long QT syndrome. Drug Metab Dispos. 2001;29:574-579.

Munger RG, Prineas RJ, Crow RS. Prolonged QT interval and risk of sudden death in South-East Asian men. Lancet. 1991;338:280-281.

Viskin S. Long QT syndromes and torsades de pointes. Lancet. 1999;354:1625-1633.

Kies SJ, Pabelick CM, Hurley HA. Anesthesia for patients with congenital long QT syndrome. Anesthesiology. 2005;102:204-210.

Jervell A. . .

Roden DM. Taking the "idio" out of "idiosyncratic": predicting torsades de pointes. Pacing Clin Electrophysiol. 1998;21:1029-1034.

Thompson A, Balser JR. Perioperative cardiac arrhythmias. Br J Anaesth. 2004;93:86-94.

Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-1022.

Lieberman JA, Stroup TS, McEvoy JP. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. 2005;353:1209-1223.

Curry TB, Gaver R, White RD. Acquired long QT syndrome and elective anesthesia in children. Paediatr Anaesth. 2006;16:471-478.

Yang T, Snyders D, Roden DM. Drug block of I (Kr): model systems and relevance of arrhytmias. J Cardiovasc Pharmacol. 2001;38:737-744.

Nattel S, Quantz MA. Pharmacological response of quinidine induced early after depolarisations in canine cardiac Purkinje fibers: insights into underlying ionic mechanisms. Cardiovasc Res. 1988;22:808-817.

Lazzara R. Amiodarone and torsades de pointes. Ann Intern Med. 1989;111:549-551.

Gintant GA, Limberis JT, McDermott JS. The canine Purkinje fiber: an in vitro model system for acquired long QT syndrome and drug-induced arrhythmogenesis. J Cardiovasc Pharmacol. 2001;37:607-618.

Straus SM, Sturkenboom MC, Bleumink GS. Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death. Eur Heart J. 2005;26:2007-2012.

Mok NS, Lo YK, Tsui PT. Ketoconazole induced torsades de pointes without concomitant use of QT interval-prolonging drug. J Cardiovasc Electrophysiol. 2005;16:1375-1377.

Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-1022.

Charbit B, Albaladejo P, Funck-Bretano C. Prolongation of the QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology. 2005;102:1094-1100.

Kudoh A. Perioperative management for chronic schizophrenic patients. Anesth Analg. 2005;101:1867-1872.

Zareba W, Moss AJ, Daubert JP. Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol. 2003;14:337-341.

Moss AJ, Zareba N, Hall WJ. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation. 2000;101:616-623.

Schwartz PJ, Snebold NG, Brow AM. Effects on unilateral cardiac sympathetic denervation on the ventricular fibrillation threshold. Am J Cardiol. 1976;37:1034-1040.

Anestesia e síndrome do QT longo

Anesthesia and the long QT syndrome

Michelle Nacur Lorentz; Flávio Gouveia Camelo Ramiro

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