Key result
Spinal anesthesia with levobupivacaine significantly prolonged QTc, QTd, and QTcd intervals compared to general anesthesia with sevoflurane during inguinal hernia operations.
Why the study?
Arrhythmias are frequently encountered during surgery, prompting investigation into the comparative effects of volatile inhalation mask anesthesia with sevoflurane versus spinal anesthesia with levobupivacaine on QT dispersion.
Does general anesthesia with sevoflurane reduce QT dispersion compared to spinal anesthesia with levobupivacaine in patients undergoing inguinal hernia operations?
RCT (n=40)
Single-blind (cardiologist evaluating ECGs was blinded)
Closed envelope method
No
Does general anesthesia with sevoflurane reduce QT dispersion compared to spinal anesthesia with levobupivacaine in patients undergoing inguinal hernia operations?
p-value: p=<0.05
General anesthesia with sevoflurane results in less QT dispersion prolongation compared to spinal anesthesia with levobupivacaine, suggesting a lower tendency toward perioperative arrhythmias.
Sevoflurane VIMA may reduce QTc prolongation versus levobupivacaine spinal in cardiac-risk patients; small Level 5 study leaves open need for larger confirmation.
Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.
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Pehlivan et al. (2020) conducted an RCT in Inguinal hernia (n=40). General anesthesia with sevoflurane vs. Spinal anesthesia with levobupivacaine (15 mg) was evaluated on Percentage changes of QT dispersion (QTd) and corrected QT dispersion (QTcd) values from the initiation period (p=<0.05). Spinal anesthesia with levobupivacaine significantly prolonged QTc, QTd, and QTcd intervals compared to general anesthesia with sevoflurane during inguinal hernia operations.
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