Yonsei Med J.  2011 Mar;52(2):333-338. 10.3349/ymj.2011.52.2.333.

The Effects of a Single Bolus of Remifentanil on Corrected QT Interval Change during Sevoflurane Induction

• Kim ES
• Chang HW

• KMID: 1779672
• DOI: http://doi.org/10.3349/ymj.2011.52.2.333

Abstract

PURPOSE
Opioids may affect changes in the corrected QT interval (QTc) during anesthetic induction. This study examine whether a single bolus of remifentanil would prolong QTc after laryngeal mask airway (LMA) insertion during sevoflurane induction.
MATERIALS AND METHODS
Forty women of American Society of Anesthesiologists physical status 1 (ASA PS1) undergoing gynecological surgery were studied. All patients were induced using three vital capacity inhalation inductions with 5% sevoflurane. Two minutes after induction, the inspiratory concentration of sevoflurane was reduced to 2%. Using double-blinded randomization, patients were allocated into one of two groups, receiving either saline (placebo group, n = 20) or 0.25 microg.kg-1 remifentanil (remifentanil group, n = 20) over a period of thirty seconds. Sixty seconds later, LMA insertion was performed. Recordings were taken with a 12-lead electrocardiogram at baseline, 2 min after induction and 1 and 3 min after LMA insertion. QTc was calculated by Bazett's formula. The mean arterial pressure (MAP) and heart rate (HR) were also measured at each time point.
RESULTS
The QTc interval was significantly prolonged in the placebo group as compared to the remifentanil group at 1 min after LMA insertion (467.8 +/- 16.5 vs. 442.7 +/- 21.3 ms, p < 0.001). However, there was no significant difference in QTc at 3 min after LMA insertion between the two groups. MAP and HR were significantly higher in the placebo group (p < 0.001).
CONCLUSION
A single bolus of remifentanil is safe method to attenuate prolonged QTc associated with insertion of LMA.

Keyword

Laryngeal mask airway; QTc; remifentanil; sevoflurane

MeSH Terms

Adult
Anesthetics, Inhalation/adverse effects/*pharmacology
Anesthetics, Intravenous/administration & dosage/*pharmacology
Electrocardiography/drug effects
Female
Gynecologic Surgical Procedures/adverse effects
Heart Rate/*drug effects
Humans
Methyl Ethers/adverse effects/*pharmacology
Middle Aged
Piperidines/*pharmacology

Figure

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  Fig. 1 Study protocol. Open bar = 5% sevoflurane, Filled bars = 2% sevoflurane; Saline or remifentanil was given after 2 min of inhalation of sevoflurane.

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  Fig. 2 Change in QTc interval (mean ± SD) at different time points under sevoflurane anesthesia. +1 and +3 min refer to time after insertion of laryngeal mask airway. *p < 0.001 when compared to the placebo groups at each time point. †p < 0.05 when compared to QTc value before anesthesia.

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  Fig. 3 Change in heart rate (HR; mean ± SD) at different time points under sevoflurane anesthesia. +1 and +3 min refer to time after insertion of laryngeal mask airway. *p < 0.001 when compared to the placebo groups at each time point. †p < 0.05 when compared to HR values before anesthesia.

• 

  Fig. 4 The change in mean arterial pressure (MAP) (mean ± SD) at different time points under sevoflurane anesthesia. +1 and +3 min refer to time after insertion of laryngeal mask airway. *p < 0.001 when compared with placebo groups at each time point. †p < 0.05 when compared to MAP values before anesthesia.

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