Sibel ÖZCAN, Aysun YILDIZ ALTUN, Özlem SEÇEN, İsmail DEMİREL

The effect of subarachnoid or epidural bupivacaine on the QTc and P-wave dispersion

Aim: Bupivacaine, which is widely used in neuraxial anesthesia, may lead to negative inotropic effect and arrhythmias. In this study,our objective is to evaluate the effects of bupivacaine on corrected QT interval (QTc) and P wave dispersion in epidural anesthesiaand to compare them with those in spinal anesthesia.Material and Methods: Ninety patients (59 male, 31 female) who applied neuraxial anesthesia for unilateral inguinal herniarepair were randomly allocated into two groups: Group S (Spinal, n = 49), Group E (Epidural, n = 41). Neuraxial anesthesia wasperformed by bupivacaine in both groups. We calculated heart rate, QT interval, corrected QT interval and P wave dispersion fromelectrocardiography, before anesthesia and after the operation.Results: Postoperative QT interval was significantly longer than preoperative value in both groups (preoperative 0.388 sec in GroupS and Group E versus, postoperative 0.407 sec in Group S and 0.397 sec in Group E), (p=0.001). Postoperative QTc prolongationwas significantly higher in Group S, but there was no statistically significant difference between the groups (preoperative 0.418sec versus, postoperative 0.424 sec in Group S), (p = 0.129). Preoperative and postoperative P wave dispersion value revealed nostatistically significant differences in both inter- and intragroup comparisons.Conclusion: Bupivacaine caused a postoperative QTc interval prolongation in spinal and epidural anesthesia, which did not reachlevels that were regarded as risky for ventricular arrhythmias despite being more prominent in the spinal anesthesia group comparedwith the epidural anesthesia group.

PDF

___

1. Owczuk R, Wujtewicz MA, Zienciuk KA, et al. The influence of anesthesia on cardiac repolarization. Minerva Anestesiol 2012;78:483-95.
2. Ornek E, Ornek D, Alkent ZP, et al. The effects of volatile induction and maintenance of anesthesia and selective spinal anesthesia on QT interval, QT dispersion, and arrhythmia incidence. Clinics (Sao Paulo) 2010;65:763-7.
3. Yee KM, Lim PO, Ogston SA, et al. Effect of phenylephrine with and without atropine on QT dispersion in healthy normotensive men. Am J Cardiol 2000;85:69-74.
4. Berde CB, Strichartz GR. Local anesthetics. In: Miller RD (ed.). Anesthesia. 7th ed. New York: ChurchillLivingstone 2010:913-41.
5. Lefrant JY, Muller L, de La Coussaye JE, et al. Hemodynamic and cardiac electrophysiologic effects of lidocaine-bupivacaine mixture in anesthetized and ventilated piglets. Anesthesiology 2003;98:96-103.
6. Buckenmaier CC, Bleckner LL. Anaesthetic agents for advanced regional anaesthesia: a North American perspective. Drugs 2005;65:745-59.
7. Casati A, Putzu M. Bupivacaine, levobupivacaine and ropivacaine: are they clinically different? Best Pract Res Clin Anaesthesiol 2005;19:247-68.
8. Oto A, (ed). Myocardial Repolarization. QT Dynamicity as a Predictor for Arrhytmia Development. Futura Publishing Company, INC. New York: Armonk 2001;173-211.
9. Luo S, Michler K, Johnston P, et al. A comparison of commonly used QT correction formulae: the effect of heart rate on the QTc of normal ECGs. J Electrocardiol 2004;37:81-90.
10. Takahara A, Sugiyama A, Satoh Y, et al. Cardiovascular profile of the canine torsades de pointes arrhythmia model assessed by echocardiographic and haemodynamic methods. Basic Clin Pharmacol Toxicol 2007;101:35-40.
11. Okin PM, Devereux RB, Howard BV, et al. Assessment of QT interval and QT dispersion for prediction of all-cause and cardiovascular mortality in American Indians: The Strong Heart Study. Circulation 2000;101:61-6.
12. Chandy J, Nakai T, Lee RJ, et al. Increases in P-wave dispersion predict postoperative atrial fibrillation after coronary artery by pass graft surgery. Anesth Analg 2004;98:303-10.
13. Dagdelen S, Yuce M, Toraman F, et al. The value of P dispersion on predicting atrial fibrillation after coronary artery by pass surgery: effect of magnesium on P dispersion. Ann Noninvasive Electrocardiol 2002;7:211-8.
14. Malik M, Batchvarov VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Coll Cardiol 2000;36:1749-66.
15. Yildirim H, Adanir T, Atay A, et al. The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG. Eur J Anaesthesiol 2004; 566-70.
16. Whyte SD, Sanatani S, Booker PD. Torsades de pointes with sevoflurane. Paediatr Anaesth 2006;16:1199- 201.
17. Karagoz AH, Basgul E, Celiker V, et al .The effect of inhalational anaesthetics on QTc interval. Eur J Anaesthesiol 2005;22:171-4.
18. Youngs PJ, Littleford J. Arrhythmias during spinal anesthesia. Can J Anaesth 2000;47:385-90.
19. Owczuk R, Sawicka W, Wujtewicz MA, et al. Infuence of spinal anesthesia on corrected QT interval. Reg Anesth Pain Med 2005;30:548-52. 20. Booker PD, Whyte SD, Ladusans EJ. Long QT syndrome and anaesthesia. Br J Anaesth 2003;90:349-66.
21. Aypar E, Karagoz AH, Ozer S, et al. The effects of sevofurane and desflurane anesthesia on QTc interval and cardiac rhythm in children. Paediatr Anaesth 2007;17:563-7.
22. Wisely NA, Shipton EA. Long QT syndrome and anaesthesia. Eur J Anaesthesiol 2002;19:853-9.
23. Dogan Z, Yildiz H, Akcay A, et al. The effect of intraspinal bupivacaine versus levobupivacaine on the QTc intervals during caesarean section: a randomized, double-blind, prospective study. Basic Clin Pharmacol Toxicol 2014;114:248-53.
24. Al-Refai A, Gunka V, Douglas J. Spinal anesthesia for cesarean section in a parturient with long QT syndrome. Can J Anesth 2004;51:993-6.
25. Guillon A, Leyre S, Remérand F, et al. Modification of Tp-e and QTc intervals during caesarean section under spinal anaesthesia. Anaesthesia 2010;65:337- 42.
26. Hanbeyoglu O, Urfalioglu A, Yazar FM, et al. Efects on QTc Interval of 2 Diferent Doses of Spinal Anesthesia in Inguinal Hernia Operations. Med Sci Monit 2017;23:1261-7.
27. Turgut O, Yilmaz MB, Yilmaz A, et al. Acute coronary syndrome: shortterm effects of early intravenous metoprolol on maximum P wave duration and P wave dispersion. Adv Ther 2007;24:14-22.
28. Camsari A, Pekdemir H, Akkus MN, et al. Longterm effects of beta blocker therapy on Pwave duration and dispersion in congestive heart failure patients: a new efect? J Electrocardiol 2003;36:111-6.
29. Altun A, Erdogan O, Tatli E, et al. Increased P wave dispersion: a new finding in patients with syndrome X. Can J Cardiol 2002;18:1207-10.
30. Twardowski P, Owczuk R, Wujtewicz MA, et al. The influence of epidural anesthesia on the electrical activity of heart atria. Kardiochir Torakochirurgia Pol 2014;11:156-61.