Abstract | BACKGROUND: METHODS: We performed a retrospective cohort study of children with LQTS undergoing general anesthesia for noncardiac surgery or device implant, or revision for cardiac rhythm management. This study was a retrospective chart review with data collection from computerized and electronic patient medical records. RESULTS: Seventy-six patients with congenital LQTS were identified who had a total of 114 anesthetic encounters. Of the 114 anesthetic encounters, there were 3 AEs, 2 definite and 1 probable AE, for an incidence of 2.6%. The events occurred in boys (aged 11, 13, and 15 years) while undergoing noncardiac surgery under volatile general anesthesia. All were receiving β-blocker therapy preoperatively. The AEs occurred in close proximity to the administration of reversal drugs (anticholinesterase/ anticholinergic combinations) and the antiemetic ondansetron. The events occurred during emergence from anesthesia, and exclusively in the group of patients who received both reversal drugs and ondansetron. All were treated successfully with short-term antiarrhythmic drug therapy and discharged the next morning. CONCLUSIONS: There is an increased risk of AEs during periods of enhanced sympathetic activity, especially emergence. This risk seems to be further enhanced if drugs are administered at this time that are known either to prolong the corrected QT interval or the transmural dispersion of repolarization or increase the incidence of tachycardia. Restriction of medications that adversely affect ion channels and intense vigilance and monitoring during this time and in the postoperative phase could help prevent occurrence or progression of AEs.
|
Authors | Aruna T Nathan, Darryl H Berkowitz, Lisa M Montenegro, Susan C Nicolson, Victoria L Vetter, David R Jobes |
Journal | Anesthesia and analgesia
(Anesth Analg)
Vol. 112
Issue 5
Pg. 1163-8
(May 2011)
ISSN: 1526-7598 [Electronic] United States |
PMID | 21346158
(Publication Type: Journal Article)
|
Copyright | © 2011 International Anesthesia Research Society |
Chemical References |
- Adrenergic beta-Antagonists
- Anesthetics, Inhalation
- Anti-Arrhythmia Agents
- Antiemetics
- Cholinergic Antagonists
- Cholinesterase Inhibitors
|
Topics |
- Adolescent
- Adrenergic beta-Antagonists
(therapeutic use)
- Age Factors
- Anesthesia Recovery Period
- Anesthesia, General
(adverse effects)
- Anesthetics, Inhalation
(adverse effects)
- Anti-Arrhythmia Agents
(therapeutic use)
- Antiemetics
(adverse effects)
- Child
- Child, Preschool
- Cholinergic Antagonists
(adverse effects)
- Cholinesterase Inhibitors
(adverse effects)
- Female
- Humans
- Long QT Syndrome
(congenital, drug therapy, physiopathology)
- Male
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Tachycardia, Ventricular
(drug therapy, etiology, physiopathology)
- Time Factors
- Torsades de Pointes
(drug therapy, etiology)
- Treatment Outcome
- Volatilization
|