J Dent Anesth Pain Med.  2015 Sep;15(3):161-165.

Dental treatment of a patient with long QT syndrome under moderate sedation with target-controlled infusion of propofol

• Kim KJ
• Hyun HK
• Kim YJ
• Kim JW
• Shin TJ

Abstract

Long QT syndrome (LQTs) is a rare congenital disorder of the heart's electrical activity. Patients with LQTs are at increased risk of developing fatal ventricular arrhythmias. Elevated levels of sympathetic stimulation can exacerbate this risk. Successful behavior management is indispensable in the treatment of patients with LQTs. However, many drugs involved in pharmacologic behavior management are known to adversely affect the QT interval. Therefore, careful selection of a sedative drug is essential in avoiding such incidences. A 10-year-old boy with a known diagnosis of LQTs required restorative treatment due to dental caries at the permanent molar. He required sedation since treatment was painful and dental phobia can trigger sympathetic stimulation, creating a dangerous situation for patients with LQTs. Therefore, the treatment was performed over two sessions under moderate sedation involving propofol combined with nitrous oxide. Restorative treatment was successful without any complications under sedation with a target-controlled infusion (TCI) of propofol. There was no significant QT prolongation during pulpal treatment. Propofol TCI may be a good candidate for sedation in patients with LQTs.

Keyword

Long QT syndrome; Moderate sedation; Propofol

MeSH Terms

Arrhythmias, Cardiac
Child
Congenital, Hereditary, and Neonatal Diseases and Abnormalities
Conscious Sedation*
Dental Anxiety
Dental Caries
Diagnosis
Humans
Incidence
Long QT Syndrome*
Male
Molar
Nitrous Oxide
Propofol*
Nitrous Oxide
Propofol

Figure

• 

  Fig. 1 Preoperative electrocardiogram. The corrected QT interval was 550 msec, significantly higher than the normal value in males (below 430 msec).

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  Fig. 2 Intraoral radiographs of the mandibular first permanent molar. The caries lesion is very extensive and close to the pulp. A periapical lesion has not yet developed, but it was still hard to exclude the possibility of an endodontic treatment.

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  Fig. 3 Intraoral photographs of the mandibular first permanent molars before and after treatment. Note that the mandibular first permanent molar, which had been endodontically treated, is restored with an adult stainless steel crown. (a) Occlusal caries of the lower right second molar are shown. (b) The carious lesion was restored with composite resin. (c) Occlusal caries of the lower left second molar are shown. (d) The lesion was also restored with composite resin.

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