Effects of Dexmedetomidine on Myocardial Repolarization in Children Undergoing General Anesthesia
| Autor: | Elizabeth D. Sherwin, Nicholas West, Matthias Görges, Simon D. Whyte, Sonia M. Brodie, Andrew K Poznikoff |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Agonist Time Factors medicine.drug_class Action Potentials Anesthesia General Risk Assessment law.invention Electrocardiography 03 medical and health sciences 0302 clinical medicine Randomized controlled trial Heart Conduction System Heart Rate Risk Factors 030202 anesthesiology law Intensive care Adrenergic alpha-2 Receptor Agonists Humans Medicine Single-Blind Method Dexmedetomidine Child Infusions Intravenous Perioperative Period Adverse effect British Columbia medicine.diagnostic_test business.industry Age Factors Perioperative Anesthesiology and Pain Medicine Child Preschool Anesthesia Female business Pediatric anesthesia 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 129:1100-1108 |
| ISSN: | 0003-2999 |
| Popis: | Dexmedetomidine is a highly selective α2-adrenergic agonist, which is increasingly used in pediatric anesthesia and intensive care. Potential adverse effects that have not been rigorously evaluated in children include its effects on myocardial repolarization, which is important given that the drug is listed as a possible risk factor for torsades de pointes. We investigated the effect of 3 different doses of dexmedetomidine on myocardial repolarization and transmural dispersion in children undergoing elective surgery with total IV anesthesia.Sixty-four American Society of Anesthesiologists I-II children 3-10 years of age were randomized to receive dexmedetomidine 0.25 µg/kg, 0.5 µg/kg, 0.75 µg/kg, or 0 µg/kg (control), as a bolus administered over 60 seconds, after induction of anesthesia. Pre- and postintervention 12-lead electrocardiograms were recorded. The interval between the peak and the end of the electrocardiogram T wave (Tp-e; transmural dispersion) and heart rate-corrected QT intervals (myocardial repolarization) were measured by a pediatric electrophysiologist blinded to group allocation. Data were analyzed using an analysis of covariance regression model. The study was powered to detect a 25-millisecond difference in Tp-e.Forty-eight children completed the study, with data analyzed from 12 participants per group. There were no instances of dysrhythmias. Tp-e values were unaffected by dexmedetomidine administration at any of the studied doses (F = 0.09; P = .96). Mean (99% CI) within-group differences were all2 milliseconds (-5 to 8). Postintervention, corrected QT interval increased in the control group, but decreased in some dexmedetomidine groups (F = 7.23; P.001), specifically the dexmedetomidine 0.5 and 0.75 µg/kg doses. Within groups, the mean (99% CI) differences between pre- and postintervention corrected QT interval were 12.4 milliseconds (-5.8 to 30.6) in the control group, -9.0 milliseconds (-24.9 to 6.9) for dexmedetomidine 0.25 µg/kg, -18.6 milliseconds (-33.7 to -3.5) for dexmedetomidine 0.5 µg/kg, and -14.1 milliseconds (-27.4 to -0.8) for dexmedetomidine 0.75 µg/kg.Of the bolus doses of dexmedetomidine studied, none had an effect on Tp-e and the dexmedetomidine 0.5 and 0.75 µg/kg doses shortened corrected QT intervals when measured at 1 minute after dexmedetomidine bolus injection during total IV anesthesia. There is no evidence for an increased risk of torsades de pointes in this context. |
| Databáze: | OpenAIRE |
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