Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, 76 Stuart St, Victory 2, Kingston, ON, K7L 2V7, Canada.
Can J Anaesth. 2010 May;57(5):453-7. doi: 10.1007/s12630-010-9288-2. Epub 2010 Mar 4.
To describe a case of ventricular tachycardia after co-administration of ondansetron and dimenhydrinate to a child with occult congenital QT prolongation.
A previously healthy 11-yr-old girl presented for surgical excision of a thyroglossal duct cyst under general anesthesia. Induction and maintenance of anesthesia were unremarkable, and the surgery was carried out without incident. Prior to emergence, ondansetron 0.1 mg.kg(-1) and dimenhydrinate 0.4 mg.kg(-1) were administered. Within approximately two minutes, polymorphic premature ventricular contractions developed and, subsequently, polymorphic ventricular tachycardia ensued. A 12-lead electrocardiogram revealed a profoundly prolonged QT interval that decreased but failed to normalize completely postoperatively. Our patient was diagnosed subsequently with congenital QT prolongation.
The QT interval is prolonged by the administration of ondansetron in a manner similar to that seen with droperidol, whereas dimenhydrinate is not considered to exert significant effects on the QT interval. Individuals with occult QT prolongation are at risk of experiencing malignant dysrhythmias when ondansetron is administered, especially in conjunction with anesthetic agents that also prolong the QT. The incidence of congenital QT prolongation in the general population has been estimated to be 1:2,500, and it may be undiagnosed preoperatively, especially in pediatric patients.
描述一例隐匿性先天性 QT 延长的儿童在合用昂丹司琼和茶苯海明后发生室性心动过速的病例。
一名既往健康的 11 岁女孩在全身麻醉下接受甲状舌管囊肿切除术。麻醉诱导和维持均无异常，手术过程顺利。在苏醒前，给予昂丹司琼 0.1mg/kg 和茶苯海明 0.4mg/kg。大约两分钟内，出现多形性室性早搏，随后发生多形性室性心动过速。12 导联心电图显示 QT 间期明显延长，术后虽有所下降但未能完全恢复正常。我们的患者随后被诊断为先天性 QT 延长。
昂丹司琼的给药方式与氟哌利多相似，可导致 QT 间期延长，而茶苯海明则不被认为对 QT 间期有显著影响。当给予昂丹司琼时，隐匿性 QT 延长的个体有发生恶性心律失常的风险，尤其是与同样延长 QT 的麻醉药物合用时。先天性 QT 延长在普通人群中的发病率估计为 1:2500，可能在术前未被诊断，尤其是在儿科患者中。
