Kim Tae Kyong, Cho Youn Joung, Lim Chae-Won, Min Jeong Jin, Choi Eue-Keun, Hong Deok Man, Jeon Yunseok
Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Daehakro 101, Jongno-gu, Seoul, 110-744, Korea.
Department of Anaesthesiology and Pain Medicine, Cheorwon Gil Hospital, Gangwon-Do, Korea.
BMC Anesthesiol. 2016 Aug 3;16(1):56. doi: 10.1186/s12871-016-0222-1.
Ramosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding affinity and more prolonged duration of action compared to ondansetron. The present study was performed to evaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients undergoing cardiac surgery.
A total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this randomised placebo-controlled trial. Patients were allocated into two groups that received intravenous injection of 0.3 mg ramosetron or normal saline during induction of anaesthesia. QTc intervals were measured before the operation, intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min after injection of ramosetron or normal saline), at the end of the operation, and on postoperative day 1.
There were no differences in mean QTc interval between groups at every time point. However, maximal change in QTc interval during surgery was higher in the ramosetron group than the placebo group (25.1 ± 22.0 vs. 17.5 ± 14.5 ms, 95 % CI 0.34-14.78, P = 0.040). Also, there were more patients with a QTc interval increase of > 60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6-18.0, P = 0.021). There were no significant differences in cardiovascular complications.
Ramosetron administered during induction of anaesthesia may affect maximal change in QTc interval during off-pump coronary artery bypass surgery. Ramosetron should be used with caution in high risk patients for developing Torsades de Pointes.
ClinicalTrials.gov NCT02139241. Registered November 12, 2013.
雷莫司琼是一种相对较新的5-羟色胺3受体拮抗剂，与昂丹司琼相比，具有更高的结合亲和力和更长的作用持续时间。本研究旨在评估雷莫司琼对接受心脏手术患者QTc间期的影响以及可能的心血管不良反应。
本随机安慰剂对照试验共纳入114例行非体外循环冠状动脉搭桥手术的患者。患者被分为两组，在麻醉诱导期间分别接受静脉注射0.3mg雷莫司琼或生理盐水。在手术前、术中（注射雷莫司琼或生理盐水后0、1、2、3、5、10、15、30、45、60、90、120和240分钟）、手术结束时及术后第1天测量QTc间期。
各时间点两组间平均QTc间期无差异。然而，雷莫司琼组手术期间QTc间期的最大变化高于安慰剂组（25.1±22.0对17.5±14.5ms，95%CI 0.34 - 14.78，P = 0.040）。此外，雷莫司琼组QTc间期增加>60ms的患者更多（5例对0例，95%CI 1.6 - 18.0，P = 0.021）。心血管并发症无显著差异。
麻醉诱导期间给予雷莫司琼可能会影响非体外循环冠状动脉搭桥手术期间QTc间期的最大变化。对于发生尖端扭转型室速的高危患者，应谨慎使用雷莫司琼。
ClinicalTrials.gov NCT02139241。2月13日注册。 2013年11月12日。
