From the Department of Anesthesiology and Perioperative Medicine (P.F., H.C., J.T.B., S.B., V.U., C.V., P.F., J.P.) the Heart Rhythm Management Center, Center of Heart and Vascular Disease (V.V., W.D., G-B.,C., P.B., C.d.A.), University Hospital Brussels the Interfaculty Center Data processing & Statistics (W.C.), Free University Brussels, Laarbeeklaan, Brussels, Belgium.
Anesthesiology. 2020 Mar;132(3):440-451. doi: 10.1097/ALN.0000000000003030.
Brugada Syndrome is an inherited arrhythmogenic disease, characterized by the typical coved type ST-segment elevation in the right precordial leads from V1 through V3. The BrugadaDrugs.org Advisory Board recommends avoiding administration of propofol in patients with Brugada Syndrome. Since prospective studies are lacking, it was the purpose of this study to assess the electrocardiographic effects of propofol and etomidate on the ST- and QRS-segments. In this trial, it was hypothesized that administration of propofol or etomidate in bolus for induction of anesthesia, in patients with Brugada Syndrome, do not clinically affect the ST- and QRS-segments and do not induce arrhythmias.
In this prospective, double-blinded trial, 98 patients with established Brugada syndrome were randomized to receive propofol (2 to 3 mg/kg) or etomidate (0.2 to 0.3 mg/kg) for induction of anesthesia. The primary endpoints were the changes of the ST- and QRS-segment, and the occurrence of new arrhythmias upon induction of anesthesia.
The analysis included 80 patients: 43 were administered propofol and 37 etomidate. None of the patients had a ST elevation greater than or equal to 0.2 mV, one in each group had a ST elevation of 0.15 mV. An ST depression up to -0.15mV was observed eleven times with propofol and five with etomidate. A QRS-prolongation of 25% upon induction was seen in one patient with propofol and three with etomidate. This trial failed to establish any evidence to suggest that changes in either group differed, with most percentiles being zero (median [25th, 75th], 0 [0, 0] vs. 0 [0, 0]). Finally, no new arrhythmias occurred perioperatively in both groups.
In this trial, there does not appear to be a significant difference in electrocardiographic changes in patients with Brugada syndrome when propofol versus etomidate were administered for induction of anesthesia. This study did not investigate electrocardiographic changes related to propofol used as an infusion for maintenance of anesthesia, so future studies would be warranted before conclusions about safety of propofol infusions in patients with Brugada syndrome can be determined.
Brugada 综合征是一种遗传性心律失常疾病，其特征为 V1 至 V3 导联的右侧胸前导联出现典型的穹窿型 ST 段抬高。BrugadaDrugs.org 顾问委员会建议避免在 Brugada 综合征患者中使用异丙酚。由于缺乏前瞻性研究，本研究旨在评估异丙酚和依托咪酯对 ST 段和 QRS 段的心电图影响。在这项试验中，假设在 Brugada 综合征患者中，单次推注诱导麻醉时使用异丙酚或依托咪酯不会对 ST 段和 QRS 段产生临床影响，也不会引起心律失常。
在这项前瞻性、双盲试验中，98 例确诊为 Brugada 综合征的患者被随机分为接受异丙酚（2 至 3mg/kg）或依托咪酯（0.2 至 0.3mg/kg）诱导麻醉。主要终点是麻醉诱导时 ST 段和 QRS 段的变化，以及新发生的心律失常。
分析包括 80 例患者：43 例给予异丙酚，37 例给予依托咪酯。无患者出现 ST 段抬高大于或等于 0.2mV，每组各有 1 例患者出现 0.15mV 的 ST 段抬高。异丙酚组观察到 11 次 ST 段压低至-0.15mV，依托咪酯组观察到 5 次。异丙酚组有 1 例患者 QRS 波群延长 25%，依托咪酯组有 3 例患者 QRS 波群延长 25%。本试验未能证实两组之间的变化有任何差异，大多数百分位数为零（中位数[25 百分位，75 百分位]，0[0，0]与 0[0，0]）。最后，两组患者围手术期均未发生新的心律失常。
在本试验中，异丙酚与依托咪酯用于诱导麻醉时，Brugada 综合征患者的心电图变化似乎没有显著差异。本研究未探讨与异丙酚用于维持麻醉的输注相关的心电图变化，因此在确定异丙酚输注在 Brugada 综合征患者中的安全性之前，还需要进行进一步的研究。
