title: Sustained prolongation of the QTc interval after anesthesia with sevoflurane in infants during the first 6 months of life.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens University, Innsbruck, Austria. alex.loeckinger@uibk.ac.at
authors.forename: Alex
authors.initials: A
authors.lastname: Loeckinger
authors.forename: Axel
authors.initials: A
authors.lastname: Kleinsasser
authors.forename: Stephan
authors.initials: S
authors.lastname: Maier
authors.forename: Bernhard
authors.initials: B
authors.lastname: Furtner
authors.forename: Christian
authors.initials: C
authors.lastname: Keller
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kuehbacher
authors.forename: Karl H
authors.initials: KH
authors.lastname: Lindner
mesh_terms: 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
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D006221:Halothane