title: Droperidol transiently prolongs the QT interval in children undergoing single ventricle palliation.
abstract: Historically, droperidol was commonly used for postoperative sedation of critically ill children. A FDA black box warning regarding its arrhythmogenic potential greatly reduced its use. We hypothesized that administration of neuroleptic dose droperidol during volatile anesthesia would transiently prolong the corrected QT interval (QTc) in patients undergoing single ventricle palliation. As part of a prospective study in children undergoing stage 2 or 3 single ventricle palliation, we recorded electrocardiograms preoperatively, after induction of volatile anesthesia, immediately after completion of 30 min intravenous infusion of 75 mcg/kg droperidol, and shortly after arrival in the cardiac intensive care unit. Mean absolute QT intervals and heart rate data were analyzed in a blinded fashion and the longest QT interval was determined. QT intervals were corrected for heart rate (QTc) with the Bazett and Friderici formulae. Any perioperative arrhythmias were recorded. Complete data were available for 62 patients. Volatile anesthesia was associated with significant prolongation of the QTc interval. Administration of droperidol after cardiopulmonary bypass was associated with further significant QTc prolongation. All QTc changes were transient and the postoperative QTc, while still prolonged relative to baseline, was significantly shorter than the QTc immediately postdroperidol. No episodes of Torsades de Pointes (TdP) or ventricular arrhythmias were observed. The administration of a neuroleptic dose of droperidol during volatile anesthesia in patients undergoing single ventricle palliation was associated with a significant prolongation of QTc, which was transient and did not result in TdP or other ventricular arrhythmias in our study population.
authors.affiliation: Section of Pediatric Anesthesia, Department of Anesthesiology, Medical College of Wisconsin, 9000 W. Wisconsin Ave, Milwaukee, WI, 53201, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Scott
authors.forename: Eckehard A E
authors.initials: EA
authors.lastname: Stuth
authors.forename: Astrid G
authors.initials: AG
authors.lastname: Stucke
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Cava
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Berens
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004329:Droperidol / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D008133:Long QT Syndrome / Q000139:chemically induced*; D008297:Male; D010166:Palliative Care; D012307:Risk Factors
chemical_list: D000759:Adjuvants, Anesthesia; D004329:Droperidol
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