七氟醚在老年患者中比在年轻患者中引起更大的 QTc 间期延长。

Sevoflurane causes greater QTc interval prolongation in elderly patients than in younger patients.

机构信息

Department of Anesthesiology, Kansai Medical University, Osaka, Japan.

出版信息

Anesth Analg. 2010 Mar 1;110(3):775-9. doi: 10.1213/ANE.0b013e3181cde713.

DOI:10.1213/ANE.0b013e3181cde713

PMID:20185656

Abstract

BACKGROUND

Sevoflurane and droperidol prolong the QT interval, and advancing age is not only associated with a prolongation of the QT interval but is also a risk factor for drug-induced QT interval prolongation. In this study, we compared the effect of sevoflurane and droperidol on the corrected QT (QTc) interval and the dispersion of ventricular repolarization (time interval from the peak to the end of the T wave [Tp-e]) in elderly patients with those in younger patients.

METHODS

Under sevoflurane anesthesia (1.5%-2.5%) with an antiemetic dose of droperidol (1.25 mg), the QT interval and the Tp-e interval, which indicates transmural dispersion of repolarization across the myocardial wall, were measured in 30 elderly patients (70 years and older) and in 30 younger patients (20-69 years) for 2 hours. The QT interval was normalized for heart rate (QTc) using 3 different formulas: Bazett, Matsunaga, and Van de Water. Data are presented as mean +/- sd.

RESULTS

The elderly group was 24.4 years older (P < 0.05) than the younger group. The QTc intervals in the 2 groups before anesthesia were not significantly different. Using all 3 formulas, the QTc interval in the elderly patient group was significantly prolonged by sevoflurane (the QTc intervals at preanesthesia and 60, 75, 90, and 120 minutes after sevoflurane exposure were 0.434 +/- 0.028 seconds, 0.450 +/- 0.037 seconds, 0.463 +/- 0.037 seconds, 0.461 +/- 0.037 seconds, and 0.461 +/- 0.038 seconds, respectively, with the Bazett formula). The sevoflurane-induced QTc interval prolongation in the elderly patient group was significantly greater than that in the younger patient group (0.450 +/- 0.037 seconds vs 0.432 +/- 0.034 seconds, 60 minutes after sevoflurane exposure; 0.463 +/- 0.037 seconds vs 0.441 +/- 0.037 seconds, 75 minutes after sevoflurane exposure; and 0.461 +/- 0.038 seconds vs 0.436 +/- 0.030 seconds, 120 minutes after sevoflurane exposure with the Bazett formula), but the sevoflurane-induced QTc interval prolongation was neither further enhanced with time nor by droperidol. The Tp-e interval was not affected in either group.

CONCLUSION

Sevoflurane causes greater QTc interval prolongation in elderly patients than in younger patients. Although sevoflurane does not affect the transmural dispersion of repolarization and sevoflurane-induced QTc prolongation does not advance with time and by droperidol administration, QT interval prolongation and its associated arrhythmias should be carefully monitored during sevoflurane anesthesia in elderly patients.

摘要

背景

七氟醚和氟哌利多可延长 QT 间期，而年龄增长不仅与 QT 间期延长有关，还是药物引起 QT 间期延长的一个危险因素。在这项研究中，我们比较了七氟醚和氟哌利多对老年患者与年轻患者校正 QT（QTc）间期和心室复极离散（从峰值到 T 波终点的时间间隔[Tp-e]）的影响。

方法

在七氟醚麻醉（1.5%至 2.5%）下给予止吐剂量的氟哌利多（1.25mg），在 30 名老年患者（年龄 70 岁及以上）和 30 名年轻患者（20 至 69 岁）中测量 QT 间期和 Tp-e 间期，持续 2 小时。QT 间期采用 3 种不同公式（Bazett、Matsunaga 和 Van de Water）进行心率校正（QTc）。数据以平均值±标准差表示。

结果

老年组比年轻组年长 24.4 岁（P<0.05）。麻醉前两组的 QTc 间期无显著差异。使用所有 3 种公式，七氟醚均可显著延长老年患者的 QTc 间期（暴露于七氟醚前和 60、75、90 和 120 分钟后的 QTc 间期分别为 0.434±0.028 秒、0.450±0.037 秒、0.463±0.037 秒、0.461±0.037 秒和 0.461±0.038 秒，采用 Bazett 公式）。老年患者组七氟醚引起的 QTc 间期延长明显大于年轻患者组（暴露于七氟醚 60 分钟后分别为 0.450±0.037 秒与 0.432±0.034 秒，75 分钟后分别为 0.463±0.037 秒与 0.441±0.037 秒，120 分钟后分别为 0.461±0.038 秒与 0.436±0.030 秒，采用 Bazett 公式），但七氟醚引起的 QTc 间期延长随时间延长或氟哌利多给药并无进一步加重。两组的 Tp-e 间期均无影响。