Effects of Anesthetics on Cardiac Repolarization in Adults: A Network Meta-Analysis of Randomized Clinical Trials.
Heart Surg Forum
; 26(6): E905-E916, 2023 Dec 28.
Article
em En
| MEDLINE
| ID: mdl-38178332
ABSTRACT
OBJECTIVES:
Prolongation of cardiac repolarization, especially the heart rate-corrected QT (QTc) interval, is associated with life-threatening dysrhythmias. This study aimed to identify the anesthetic with the lowest risk of prolonging cardiac repolarization and provide guidance for anesthesia management in patients with cardiac diseases or long QT syndrome.METHODS:
Randomized controlled trials (RCTs) comparing the effects of anesthetics on cardiac repolarization indices were searched for in multiple databases. The primary outcome was QTc; and the secondary outcomes were other repolarization indices. A network meta-analysis was conducted using a frequentist approach and registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022304970).RESULTS:
Thirteen RCTs investigating 953 adults with normal QTc interval and without cardiovascular diseases were included. Direct meta-analyses found that propofol had less influence than sevoflurane (95% confidence interval (CI) 16.10, 33.54) and desflurane (95% CI 4.85, 35.36), and sevoflurane had less influence than desflurane (95% CI 6.96, 19.39) on QTc prolongation. Network analysis found that propofol had less influence than sevoflurane (95% CI 17.78, 29.63), halothane (95% CI 11.29, 41.24), desflurane (95% CI 23.79, 39.88), and isoflurane (95% CI 20.11, 46.10), and sevoflurane had less influence than desflurane (95% CI 0.43, 15.82) on QTc prolongation. The rank order of cumulative ranking curve analysis was propofol (100%), sevoflurane (63.8%), halothane (49.5%), desflurane (21.1%), and isoflurane (15.6%). The direct meta-analysis found that propofol had less influence than sevoflurane on QT prolongation (95% CI 23.12, 57.86). Other secondary outcomes showed no conclusive findings.CONCLUSIONS:
This meta-analysis found that propofol had a minimal effect on QTc prolongation, followed by sevoflurane and desflurane in adults with normal QTc interval and without cardiovascular diseases. Propofol is the best anesthetic for adult patients with long QT syndrome or cardiac diseases, but still needs more robust evidence.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Síndrome do QT Longo
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Doenças Cardiovasculares
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Propofol
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Anestésicos Inalatórios
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Isoflurano
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Éteres Metílicos
Tipo de estudo:
Clinical_trials
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Prognostic_studies
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Systematic_reviews
Limite:
Adult
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Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article