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PEDIATRIC ANESTHESIA

The Effects of Propofol and Sevoflurane on the QT Interval and Transmural Dispersion of Repolarization in Children

Jackson-Rees Department of Anesthesia, Royal Liverpool Children’s Hospital and the Liverpool University Department of Anesthesia, Liverpool, UK

Address correspondence and reprint requests to Simon D. Whyte, MB, BS, FRCA, BC Children’s Hospital, Department of Anesthesia, Room 1L7, 4480 Oak Street, Vancouver, BC, V6H 3V4. Address e-mail to sdwhyte{at}bigfoot.com

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.

IMPLICATIONS: This study indicates that although propofol and sevoflurane both prolong the corrected QT interval in healthy children, neither anesthetic increases transmural dispersion of repolarization, implying a small risk of inducing torsades de pointes.

This article has been cited by other articles:

				H. V. Hume-Smith, S. Sanatani, J. Lim, A. Chau, and S. D. Whyte The Effect of Propofol Concentration on Dispersion of Myocardial Repolarization in Children Anesth. Analg., September 1, 2008; 107(3): 806 - 810. [Abstract] [Full Text] [PDF]

				J. D. Hunter, P. Sharma, and S. Rathi Long QT syndrome CEACCP, April 1, 2008; 8(2): 67 - 70. [Full Text] [PDF]

				S. D. Whyte, S. Sanatani, J. Lim, and P. D. Booker A Comparison of the Effect on Dispersion of Repolarization of Age-Adjusted MAC Values of Sevoflurane in Children Anesth. Analg., February 1, 2007; 104(2): 277 - 282. [Abstract] [Full Text] [PDF]

				A. Rofaeel, P. Peng, I. Louis, and L. Iskander 26398 - QT INTERVAL AND T WAVE DISPERSION ASSOCIATED WITH CHRONIC METHADONE THERAPY Can J Anesth, June 1, 2006; 53(suppl_1): 26398 - 26398. [Full Text] [PDF]

				R. Owczuk, M. A. Wujtewicz, W. Sawicka, J. Lasek, and M. Wujtewicz Desflurane's Effect on QTc Interval: Electrophysiological Mechanisms Need to Be Explored Anesth. Analg., May 1, 2006; 102(5): 1593 - 1593. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999