Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran.
Skull Base Research Center, The Five Senses Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Int J Pediatr Otorhinolaryngol. 2020 May;132:109896. doi: 10.1016/j.ijporl.2020.109896. Epub 2020 Jan 22.
Congenital hearing loss is associated with cardiac rhythm disturbances namely long Q-T syndrome. This study was designed to investigate the effect of anti-emetic doses of ondansetron and dexamethasone on ECG recordings in children undergoing cochlear implant surgery.
Sixty-three pediatric patients scheduled for elective cochlear implantation were enrolled in the study. Two patients were excluded as their baseline ECG showed long QT syndrome. Anesthesia was induced with fentanyl, propofol and atracurium and maintained with propofol. Dexamethasone 0.1 mg.kgor ondansetron 0.2 mg.kgwas randomly administered for the participants approximately 30 min before the end of surgery. ECG recording was performed 15 min after induction of anesthesia and 15 min after dexamethasone/ondansetron administration. RR interval, QRS duration, QT interval, and Tp-e interval were measured by a blinded cardiologist.
Ondansetron resulted in no significant changes in RR, JTc and QTc intervals; while prolongedTp-e interval. Multivariable logistic regression analysis showed that use of ondansetron was an independent predictor of QTc prolongation after adjustment for age, gender and baseline QTc (OR = 17.94, CI 95% 1.97-168.70, p = 0.011). The incidence of postoperative retching/vomiting in ondansetron group was significantly lower than dexamethasone group. (3.2% vs. 26.7%, p = 0.011).
The risk of arrhythmias with the use of ondansetron in otherwise healthy candidates of cochlear implant is very low. However, the drug may induce significant changes in ECG parameters. The clinical significance of these changes in patients with cardiac conduction abnormalities should be investigated in further studies.
先天性听力损失与心律失常有关，即长 QT 综合征。本研究旨在探讨昂丹司琼和地塞米松的止吐剂量对接受人工耳蜗植入手术的儿童心电图记录的影响。
本研究纳入了 63 名计划行人工耳蜗植入的儿科患者。由于基线心电图显示长 QT 综合征，有 2 名患者被排除在外。麻醉诱导使用芬太尼、丙泊酚和阿曲库铵，维持使用丙泊酚。地塞米松 0.1mg/kg 或昂丹司琼 0.2mg/kg 随机给予参与者，大约在手术结束前 30 分钟。麻醉诱导后 15 分钟和地塞米松/昂丹司琼给药后 15 分钟进行心电图记录。由一位盲法心脏病专家测量 RR 间期、QRS 持续时间、QT 间期和 Tp-e 间期。
昂丹司琼对 RR、JTc 和 QTc 间期没有显著影响；而 Tp-e 间期延长。多变量逻辑回归分析显示，在调整年龄、性别和基线 QTc 后，使用昂丹司琼是 QTc 延长的独立预测因素（OR=17.94，95%CI 1.97-168.70，p=0.011）。昂丹司琼组术后恶心/呕吐的发生率明显低于地塞米松组（3.2%比 26.7%，p=0.011）。
在人工耳蜗植入的其他健康候选者中，使用昂丹司琼的心律失常风险非常低。然而，该药物可能会引起心电图参数的显著变化。在进一步的研究中，应调查这些变化在有心脏传导异常的患者中的临床意义。
