Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000400012
Brazilian Journal of Anesthesiology
Review Article

Efeitos do propofol sobre o sistema de condução cardíaca

Effects of propofol on the cardiac conduction system

Paulo Warpechowski; Ari Tadeu Lírio dos Santos; Paulo José Irigon Pereira; Gustavo Glotz de Lima

http://dx.doi.org/10.1590/S0034-70942010000400012 Braz J Anesthesiol, vol.60, n4, p.441-444, 2010
PDF Português
PDF English
Downloads: 0
Views: 1085

Resumo

JUSTIFICATIVA E OBJETIVOS: Alguns estudos têm demonstrado que o uso do propofol é, algumas vezes, associado a bradiarritmias ou reversão de arritmias para ritmo sinusal. Essa propriedade do propofol sugere interferência no Sistema de Condução Cardíaco (SCC). CONTEÚDO: Realizou-se revisão com base nos principais artigos contemporâneos que englobam o uso do propofol na presença de arritmias cardía cas. Os autores discorrem sobre os mecanismos fisiopatológicos das taquiarritmias supraventriculares (TSV) e as eventuais interferências causadas pelo propofol sobre o SCC. CONCLUSÕES: Os estudos realizados até então parecem indicar que, provavelmente, o propofol interfere nas TSV automáticas (pelo menos em crianças), mas não nas taquiarritmias em que o mecanismo seja de reentrada.

Palavras-chave

ANESTÉSICOS, Venoso, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Some studies have demonstrated that the use of propofol is occasionally associated with bradyarrhythmias or reversion of arrhythmias to sinus rhythm. This property of propofol suggests interference with the Cardiac Conduction System (CCS). CONTENTS: A review of the main contemporary articles on the use of propofol in the presence of cardiac arrhythmias was undertaken. The authors describe pathophysiological mechanisms of supraventricular tachyarrhythmias (SVT) and occasional interferences caused by propofol on the CCS. CONCLUSIONS: The studies undertaken so far seem to indicate that propofol probably interferes in automatic SVT (at least in children), but not in reentrant tachyarrhythmias.

Keywords

ANESTHETICS, Intravenous, COMPLICATIONS

References

Oliveira LF. Bloqueadores Neuromusculares: Bases Científicas e Uso Clínico em Anestesiologia. 2002:87-97.

Stoelting RK. Neuromuscular-Blocking Drugs. Pharmacology and Physiology in Anesthetic Practice. 1999:182-223.

Stoelting RK. Opioid Agonists and Antagonists. Pharmacology and Physiology in Anesthetic Practice. 1999:77-112.

Pruett JK, Blair JR, Adams RJ. Cellular and Subcellular Actions of Opioids in the Heart. Opioids in Anesthesia. 1991:61-71.

Miró O, de la Red G, Fontanals J. Cessation of paroxysmal atrial fibrillation during acute intravenous propofol administration. Anesthesiology. 2000;92.

Kannan S, Sherwood N. Termination of supraventricular tachycardia by propofol. Br J Anaesth. 2002;88:874-875.

Renwick J, Kerr C, McTaggart R. Cardiac electrophysiology and conduction pathway ablation. Can J Anaesth. 1993;40:1053-1064.

Deshpande S, Jazayeri M, Dhala A. Selective Transcatheter Modification of the Atrioventricular Node. Catheter Ablation of Arrhythmias. 1994:151-186.

Hug CC, McLeskey CH, Nahrwold NL. Hemodynamic effects of propofol- data from 24,771 patients. Anesth Analg. 1993;76.

Vuyk J, Engbers FHM, Lemmens HJM. Pharmacodynamics of propofol in female patients. Anesthesiology. 1992;77:3-9.

Thomsom SJ, Yate PM. Bradycardia after propofol infusion. Anaesthesia. 1987;42.

Seki S, Ichimiya T, Tsuchida H. A case normalization of WolffParkinson-White syndrome conduction during propofol anesthesia. Anesthesiology. 1999;90:1779-1781.

Burjorjee JE, Milne B. Propofol for electrical storm: a case report of cardioversion and suppression of ventricular tachycardia by propofol. Can J Anaesth. 2002;49:973-977.

Reves JG, Glass PSA, Lubarsky DA. Intravenous Nonopioid Anesthetics. Miller's Anesthesia. 2005:318-368.

Tramèr MR, Moore RA, Mcquay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth. 1997;78:642-651.

Alphin RS, Martens JR, Dennis DM. Frequency-dependent effects of propofol on atrioventricular nodal conduction in guinea pig isotated heart: Mechanism and potencial antidysrrhythmic properties. Anesthesiology. 1995;83:382-94.

Hermann R, Vettermann J. Change of ectopic supraventricular tachycardia to sinus rhythm during administration of propofol. Anesth Analg. 1992;75:1030-1032.

Deutschman CS, Harris AP, Fleisher LA. Changes in heart rate variability under propofol anesthesia: a possible explanation for propofolinduced bradycardia. Anesth Analg. 1994;79:373-377.

Hidaka S, Kawamoto M, Kurita S. Comparison of the effects of propofol and midazolam on the cardiovascular autonomic nervous system during combined spinal and epidural anesthesia. J Clin Anesth. 2005;17:36-43.

Pires LA, Huang SKS, Wagshal AB. Electrophysiological effects of propofol on the normal cardiac conduction system. Cardiology. 1996;87:319-324.

Ikeno S, Akazawa S, Shimizu R. Propofol does not affect the canine cardiac conduction system under autonomic blockade. Can J Anaesth. 1999;46:148-153.

Napolitano CA, Raatikainen MJP, Martens JR. Effects on intravenous anesthetics on atrial wavelength and atrioventricular nodal conduction in guinea pig heart: Potential antidysrhythmic properties and clinical implications. Anesthesiology. 1996;85:393-402.

Wu MH, Su MJ, Sun SSM. Age-related propofol effects on electrophysiological properties of isolated hearts. Anesth Analg. 1997;84:964-971.

Sharpe MD, Dobkowski WB, Murkin JM. Propofol has no direct effect on sinoatrial node function or on normal atrioventricular and accessory pathway conduction in Wolf-Parkinson-White syndrome during alfentanil/midazolam anesthesia. Anesthesiology. 1995;82:888-895.

Lavoie J, Walsh EP, Burrows FA. Effects of propofol or isofluorane anesthesia on cardiac conduction in children undergoing radiofrequency catheter ablation for tachydysrhythmias. Anesthesiology. 1995;82:884-887.

Romano R, Ciccaglioni A, Fattorini F. Effects of propofol on the human heart electrical system: a transesophageal pacing electrophysiologic study. Acta Anaesthesiol Scand. 1994;38:30-32.

Erb TO, Kanter RJ, Hall JM. Comparison of electrophysiologic effects of propofol and isoflurane-based anesthetics in children undergoing radiofrequency catheter ablation for supraventricular tachycardia. Anesthesiology. 2002;96:1386-1394.

Wu MH, Lin JL, Lai LP. Radiofrequency catheter ablation of tachycardia in children with and without congenital heart disease: indications and limitations. Int J Cardiol. 2000;72:221-227.

Lai LP, Lin JL, Wu MJ. Usefulness of intravenous propofol anesthesia for radiofrequency catheter ablation in patients with tachyarrhythmias: infeasibility for pediatric patients with ectopic atrial tachycardia. Pacing Clin Electrophysiol. 1999;22:1358-1364.

Warpechowski P, Lima GG, Medeiros CM. Randomized study of propofol effect on electrophysiological properties of the atrioventricular node in patients with nodal reentrant tachycardia. Pacing Clin Electrophysiol. 2006;29:1375-1382.

5dceb6f30e8825e505bf58f2 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