title: Torsade de pointes during sevoflurane anesthesia and fluconazole infusion in a patient with long QT syndrome. A case report.
abstract: We present the occurrence of 'torsade de pointes' induced by the combination of peroperative fluconazole administration and sevoflurane anesthesia in a patient with 'long QT syndrome' (LQTS) scheduled for resection of a sacral abscess. Eight minutes following uneventful induction of anesthesia 'torsade de pointes' occurred, terminated by a counter shock. At this time the end-tidal concentration of sevoflurane was 2%. The fluconazole infusion was disconnected and the operation was continued. Post-operatively the patient awakened uneventfully. The direct postoperative ECG showed a QTc of 531 ms (preoperative QTc of 442 ms.) and remained prolonged afterwards. A long QT syndrome was the most likely diagnosis. LQTS is classified as either congenital or acquired. Patients with acquired LQTS may have an underlying predisposition for QT prolongation. Many drugs have shown to be associated with a prolonged QT interval (1). The syndrome in this particular patient was unmasked by sevoflurane. Concomitant administration of fluconazole might have further predisposed the patient to the development of 'torsade des pointes'. Although LQTS is relatively rare, it is important for the anesthesiologist to be familiar with the disease because of the associated morbidity and mortality and the potential for anesthesia to induce malignant arrhythmias in asymptomatic carriers.
authors.affiliation: Department of Anesthesiology, Catharina Hospital Eindhoven, the Netherlands.
authors.forename: M C T
authors.initials: MC
authors.lastname: Tacken
authors.forename: F A L E
authors.initials: FA
authors.lastname: Bracke
authors.forename: A A J
authors.initials: AA
authors.lastname: Van Zundert
mesh_terms: D000038:Abscess / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000935:Antifungal Agents / Q000009:adverse effects*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D015725:Fluconazole / Q000009:adverse effects*; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications*; D008738:Methyl Ethers / Q000009:adverse effects*; D012447:Sacrum / Q000601:surgery; D000077149:Sevoflurane; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D018685:Anesthetics, Inhalation; D000935:Antifungal Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D015725:Fluconazole