Prolongation of the QT-interval during induction of anesthesia in patients with coronary artery disease.
During induction of anesthesia in 60 patients undergoing coronary artery bypass grafting (CABG), we measured the QT-interval (QTI) in the ECG, heart rate (HR) and mean arterial pressure (MAP). Based on the HR, we corrected the QT-interval (QTcI). Prior to induction, six patients (10%) already had abnormal prolongation of QTcI (> or = 440 ms). After injection of fentanyl and vecuronium, the QTcI increased significantly (P < 0.01); to a far lesser extent after injection of hypnotics (i.e. etomidate, midazolam or propofol). Orotracheal intubation caused significant shortening of QTcI (P < 0.01). HR decreased markedly after injection of fentanyl. MAP decreased, however, only after injection of hypnotics. In the immediate post intubation period, HR and MAP increased significantly. The various hypnotics produced no significant difference in HR and QTcI at any measurement point. MAP changed only after injection of hypnotics. The decrease of HR and MAP during induction of anesthesia is thought to result from a corresponding reduction of adrenosympathetic stimulation. We believe that QTcI is similarly influenced.
Lischke
V
V
Department of Anesthesiology and Resuscitation, J.W. Goethe-University Hospital, Frankfurt/Main, Germany.
Wilke
H J
HJ
Probst
S
S
Behne
M
M
Kessler
P
P
D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D003327:Coronary Disease / Q000503:physiopathology; D004562:Electrocardiography / Q000187:drug effects*; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D008875:Middle Aged; D015742:Propofol / Q000494:pharmacology*; D013997:Time Factors; D016276:Ventricular Function / Q000187:drug effects
D008874:Midazolam; D005283:Fentanyl; D015742:Propofol; D005045:Etomidate