What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=60). Intervention: Induction of anesthesia (fentanyl, vecuronium, and hypnotics) vs. Baseline (prior to induction). Primary outcome: Corrected QT-interval (QTcI), heart rate (HR), and mean arterial pressure (MAP) (p=<0.01).

February 1, 1994

Prolongation of the QT–interval during induction of anesthesia in patients with coronary artery disease

Q: What are the key findings of this study?

Injection of fentanyl and vecuronium during anesthesia induction significantly increased the corrected QT-interval (P<0.01), whereas orotracheal intubation caused significant shortening (P<0.01).

Key Result

Injection of fentanyl and vecuronium during anesthesia induction significantly increased the corrected QT-interval (P<0.01), whereas orotracheal intubation caused significant shortening (P<0.01).

Study Design

Type

Observational (n=60)

Structured PICO

How does induction of anesthesia affect the corrected QT-interval, heart rate, and mean arterial pressure in patients undergoing CABG?

Population

60 patients with coronary artery disease undergoing coronary artery bypass grafting (CABG).

Exposure

Induction of anesthesia including injection of fentanyl, vecuronium, hypnotics (etomidate, midazolam, or propofol), and orotracheal intubation

Comparator

Baseline (prior to induction)

Outcome

Changes in corrected QT-interval (QTcI), heart rate (HR), and mean arterial pressure (MAP)surrogate

Induction of anesthesia with fentanyl and vecuronium significantly prolongs the QTc interval in CABG patients, an effect that is subsequently reversed by orotracheal intubation.

Main Result

p-value: p=<0.01

Abstract

During induction of anesthesia in 60 patients undergoing coronary artery bypass grafting (CABG), we measured the QT-interval (QTI) in the ECG, heart rate (HR) and mean arterial pressure (MAP). Based on the HR, we corrected the QT-interval (QTcI). Prior to induction, six patients (10%) already had abnormal prolongation of QTcI (> or = 440 ms). After injection of fentanyl and vecuronium, the QTcI increased significantly (P < 0.01); to a far lesser extent after injection of hypnotics (i.e. etomidate, midazolam or propofol). Orotracheal intubation caused significant shortening of QTcI (P < 0.01). HR decreased markedly after injection of fentanyl. MAP decreased, however, only after injection of hypnotics. In the immediate post intubation period, HR and MAP increased significantly. The various hypnotics produced no significant difference in HR and QTcI at any measurement point. MAP changed only after injection of hypnotics. The decrease of HR and MAP during induction of anesthesia is thought to result from a corresponding reduction of adrenosympathetic stimulation. We believe that QTcI is similarly influenced.

KI fragen

Bookmark