title: The effects of propofol and sevoflurane on the QT interval and transmural dispersion of repolarization in children.
abstract: Prolongation of the QT interval is associated with torsades de pointes (TdP), especially in children or young adults with long QT syndromes. Susceptibility to TdP arises from increased transmural dispersion of repolarization (TDR) across the myocardial wall. Several anesthetic drugs prolong the QT interval, but their effect on TDR is unknown. TDR can be measured on the electrocardiograph (ECG) as the time interval between the peak and end of the T wave (Tp-e). We investigated the effects of propofol and sevoflurane on the corrected QT (QTc) and Tp-e intervals in 50 unpremedicated ASA physical status I-II children, aged 1-16 yr, who were randomized to receive propofol (group P) or sevoflurane (group S). Twelve-lead ECGs were recorded preoperatively and intraoperatively. Sevoflurane significantly prolonged the preoperative QTc; propofol did not. Neither anesthetic had any significant effect on the preoperative Tp-e. Sevoflurane increases the duration of myocardial repolarization in children to a larger extent than does propofol, but as the dispersion of repolarization appears unaffected, the risk of TdP is likely to be minimal with either anesthetic.
authors.affiliation: Jackson-Rees Department of Anesthesia, Royal Liverpool Children's Hospital and the Liverpool University Department of Anesthesia, Liverpool, UK.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Whyte
authors.forename: Peter D
authors.initials: PD
authors.lastname: Booker
authors.forename: David G
authors.initials: DG
authors.lastname: Buckley
mesh_terms: D000293:Adolescent; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006321:Heart / Q000502:physiology; D006801:Humans; D007223:Infant; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D016343:Monitoring, Intraoperative; D015742:Propofol / Q000009:adverse effects*; D000077149:Sevoflurane; D013514:Surgical Procedures, Operative
chemical_list: D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol