Anaesthesia, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
The University of Adelaide, Adelaide, South Australia, Australia.
BMJ Open. 2019 Apr 24;9(4):e028111. doi: 10.1136/bmjopen-2018-028111.
Esmolol is an ultra-short-acting β antagonist that has been shown to attenuate the corrected QT (QTc) interval prolongation associated with laryngoscopy and endotracheal intubation (LTI). Prolongation of the QTc interval can precipitate arrhythmias, the most serious of which is torsades de pointes . The aim of this systematic review was to compare esmolol and placebo on QTc changes occurring during LTI.
PubMed, EMBASE, Cochrane Registry of Clinical Trials and CINAHL databases (up to August 2018) were screened for randomised controlled trials comparing esmolol and placebo on QTc changes during LTI in cardiac and non-cardiac surgeries. The primary outcome was QTc changes during LTI and secondary outcome was related to adverse effects from esmolol such as bradycardia and hypotension.
Seven trials were identified involving 320 patients, 160 patients receiving esmolol or placebo apiece. A shortening of the QTc post-LTI was evident in the esmolol group compared with the placebo in four studies. Compared with the baseline, the QTc was reduced post-LTI in the esmolol group. In the placebo group, the QTc was prolonged compared with the baseline post LTI. Nonetheless, esmolol did not prevent QTc prolongation in the remaining three studies, and much of this was attributed to employing QTc prolonging agents for premedication and anaesthetic induction. No significant adverse events were noted.
Compared with placebo, esmolol reduced the LTI-induced QTc prolongation when current non-QTc prolonging agents were chosen for tracheal intubation. Future studies should explore whether transmural dispersion (a marker of torsadogenicity) is also affected during LTI by analysing parameters such as the Tp-e interval (interval between the peak to the end of the T-wave) and Tp-e/QTc (rate corrected Tp-e interval).
CRD42018090282.
依托咪酯是一种超短效β受体拮抗剂，已被证明可减轻喉镜和气管插管（LTI）相关的校正 QT（QTc）间期延长。QTc 间期延长可引发心律失常，其中最严重的是尖端扭转型室性心动过速。本系统评价的目的是比较依托咪酯和安慰剂在 LTI 期间 QTc 变化。
检索 PubMed、EMBASE、Cochrane 临床试验注册库和 CINAHL 数据库（截至 2018 年 8 月），以查找比较心脏和非心脏手术中依托咪酯和安慰剂在 LTI 期间 QTc 变化的随机对照试验。主要结局为 LTI 期间的 QTc 变化，次要结局为依托咪酯引起的不良反应，如心动过缓和低血压。
共确定了 7 项试验，涉及 320 例患者，每组 160 例患者接受依托咪酯或安慰剂。4 项研究表明，与安慰剂相比，依托咪酯组在 LTI 后 QTc 缩短。与基线相比，依托咪酯组 LTI 后 QTc 降低。在安慰剂组，与 LTI 后基线相比，QTC 延长。然而，在其余 3 项研究中，依托咪酯并未预防 QTc 延长，这主要归因于使用 QTc 延长剂进行术前用药和麻醉诱导。未观察到明显的不良事件。
与安慰剂相比，当选择当前非 QTc 延长剂进行气管插管时，依托咪酯可减少 LTI 引起的 QTc 延长。未来的研究应通过分析 Tp-e 间期（T 波峰至结束的间期）和 Tp-e/QTc（校正的 Tp-e 间期率）等参数，探讨在 LTI 期间是否还会影响跨壁弥散（致扭转型室性心动过速的标志物）。
CRD42018090282。
