title: Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak-Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study.
abstract: Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak-Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position.Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO2, and end-tidal sevoflurane concentrations were assessed as well.Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (PGroup × Time = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups.Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO2 pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy.
authors.affiliation: From the Department of Anesthesiology and Pain Medicine (NYK, DWH, JCK, JMP, SYK); Anesthesia and Pain Research Institute (NYK, DWH, JCK, SYK); Department of Urology, Urological Science Institute (KHR); Department of Research Affairs, Biostatistics Collaboration Units (JHH), Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Na Young
authors.initials: NY
authors.lastname: Kim
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Han
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Koh
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Hong
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Park
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000368:Aged; D020927:Dexmedetomidine / Q000494:pharmacology*; D004311:Double-Blind Method; D018475:Head-Down Tilt; D006329:Heart Conduction System / Q000187:drug effects*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D065287:Robotic Surgical Procedures / Q000379:methods
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine