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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Loeckinger
Alex
A
Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens University, Innsbruck, Austria. alex.loeckinger@uibk.ac.at
Kleinsasser
Axel
A
Maier
Stephan
S
Furtner
Bernhard
B
Keller
Christian
C
Kuehbacher
Gabriele
G
Lindner
Karl H
KH
D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006221:Halothane / Q000494:pharmacology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008738:Methyl Ethers / Q000493:pharmacokinetics / Q000494:pharmacology*; D011446:Prospective Studies; D000077149:Sevoflurane; D013997:Time Factors
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D006221:Halothane