Loeckinger Alex, Kleinsasser Axel, Maier Stephan, Furtner Bernhard, Keller Christian, Kuehbacher Gabriele, Lindner Karl H
Department of Anesthesiology and Critical Care Medicine, The Leopold-Franzens University, Innsbruck, Austria.
Anesthesiology. 2003 Mar;98(3):639-42. doi: 10.1097/00000542-200303000-00011.
Sevoflurane, an inhalational anesthetic frequently administered to infants, prolongs the QT interval of the electrocardiogram in adults. A long QT interval resulting in fatal arrhythmia may also be responsible for some cases of sudden death in infants. As the QT interval increases during the second month of life and returns to the values recorded at birth by the sixth month, we evaluated the effect of sevoflurane on the QT interval during and after anesthesia in this particular population.
In this prospective two-group trial we examined pre-, peri-, and postoperative electrocardiograms of 36 infants aged 1 to 6 months scheduled for elective inguinal or umbilical hernia repair. Anesthesia was induced and maintained with either sevoflurane, or the well-established pediatric anesthetic halothane. Heart rate corrected (c) QTc and JTc interval (indicator of intraventricular conduction delays) were recorded from electrocardiograms before and during anesthesia, and at 60 min after emergence from anesthesia.
Prolonged QTc was observed during sevoflurane anesthesia (mean [+/-SD], 473 +/- 19 ms, P< 0.01). Sixty minutes after emergence from anesthesia, QTc was still prolonged (433 +/- 15 ms) in infants treated with sevoflurane compared with those treated with halothane (407 +/- 33 ms, P< 0.01). Analogous differences were found for the JTc interval.
Despite a shorter elimination time than better known inhalational anesthetics, sevoflurane induction and anesthesia results in sustained prolongations of QTc and JTc interval in infants in the first 6 months of life. Electrocardiogram monitoring until the QTc interval has returned to preanesthetic values may increase safety after sevoflurane anesthesia.
七氟醚是一种常用于婴儿的吸入性麻醉剂，可延长成人的心电图QT间期。长QT间期导致的致命性心律失常也可能是一些婴儿猝死病例的原因。由于QT间期在出生后第二个月会增加，并在第六个月恢复到出生时记录的值，我们评估了七氟醚在这一特定人群麻醉期间及麻醉后对QT间期的影响。
在这项前瞻性两组试验中，我们检查了36例年龄在1至6个月、计划进行择期腹股沟或脐疝修补术的婴儿术前、术中及术后的心电图。分别用七氟醚或成熟的儿科麻醉剂氟烷诱导和维持麻醉。记录麻醉前、麻醉期间及麻醉苏醒后60分钟心电图上的心率校正QTc和JTc间期（室内传导延迟指标）。
七氟醚麻醉期间观察到QTc延长（平均值[±标准差]，473±19毫秒，P<0.01）。与接受氟烷治疗的婴儿相比，接受七氟醚治疗的婴儿在麻醉苏醒后6０分钟时QTc仍延长（433±15毫秒）（407±33毫秒，P<0.01）。JTc间期也发现了类似差异。
尽管七氟醚的消除时间比其他更知名的吸入性麻醉剂短，但七氟醚诱导和麻醉会导致6个月以下婴儿的QTc和JTc间期持续延长。在QTc间期恢复到麻醉前值之前进行心电图监测可能会提高七氟醚麻醉后的安全性。
